Is the Homocysteine Level a Good Predictive Marker for Evaluating Kidney Function in Patients After Percutaneous Nephrolithotomy?
Abstract
Materials and Methods: Twenty-three patients with kidney stones underwent PNL and blood samples were taken preoperatively as well as at 48 hours and three months after the operation. The homocysteine level was determined by high pressure liquid chromatography and the fluorometric method in blood samples with ethylenediaminetetraacetic
acid. The Cockcroft – Gault formula was used to calculate the glomerular filtration rate (GFR). Non-contrast computed tomography was performed for all patients before surgery. Stone burden was calculated as
the sum of the area of each stone in mm2.
Results: Fourteen male (60.9%) and nine female (39.1%) patients were recruited for this study, and the median age was 44.3 ± 15.17 (20 – 71) years. There were no statistically significant differences between the preoperative homocysteine level and the level at 48 hours post-operation (P = .460). However, the homocysteine level three months after the operation was significantly lower than the preoperative and 48 hour levels (P = .001 and P = .003, respectively).
Conclusion: Renal function, which deteriorated after the PNL procedure, was preserved or improved over time. Homocysteine may be a sensitive indicator to assess the change in renal function pre-and post-PNL.
References
C. Türk, T. Knoll, A. Petrik, K. et al Guidelines Associates: S. Dabestani, T. Drake, N. Grivas, Y. Ruhayel, A.K. Tepeler. European Association of Urology. 2016 Guidelines on Urolithiasis.
Nouralizadeh A, Sichani MM, Kashi AH. Impacts of percutaneous nephrolithotomy on the estimated glomerular filtration rate during
the first few days after surgery. Urol Res. 2011;39:129-33.
Kim SJ, Choi D, Ko YG et al. Relation of homocysteinemia to contrast-induced nephropathy in patients undergoing percutaneous coronary intervention. Am J Cardiol. 2011; 108:1086-91.
Monfared A, Azimi SZ, Kazemnezhad E et al. Hyperhomocysteinemia and assessment of its associated factors in renal transplant recipients: a single-center study in northern Iran. Transplantation. 2014; 98:66-71.
Chen CH, Yang WC, Hsiao YH, Huang SC, Huang YC. High homocysteine, low vitamin B-6 and increased oxidative stress are independently associated with the risk of chronic kidney disease. Nutrition. 2016;
:236-41.
Söylemez H, Bozkurt Y, Penbegül N et al. Time-dependent oxidative stress effects of percutaneous nephrolithotomy. Urolithiasis. 2013; 41:65-71.
Chatham JR, Dykes TE, Kennon WG. Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyl triglycine nuclear renography. Urology. 2002;59:522-26.
Pérez-Fentes D, Cortés J, Gude F. Does percutaneous nephrolithotomy and its outcomes have an impact on renal function? Quantitative analysis using SPECT-CT DMSA. Urolithiasis. 2014; 42:461-67.
Handa RK, Johnson CD, Connors BA, Evan AP, Lingeman JE, Liu Z. Percutaneous Renal Access: Surgical Factors Involved in the Acute
Reduction of Renal Function. J Endourol. 2016; 30:178-83.
Hoffman M. Hypothesis: hyperhomocysteinemia is an indicator of oxidant stress. Med Hypotheses. 2011; 77:1088-93.
Solomon LR. Low Cobalamin (Vitamin B12) Levels as Predictors of Cobalamin Deficiency: Importance of Comorbidities Associated With
Increased Oxidative Stress. Am J Med. 2016;129:115.e9-115.e16.
Dawson SL, Bowe SJ, Crowe TC. A combination of omega-3 fatty acids, folic acid and B-group vitamins is superior at lowering homocysteine than omega-3 alone: A metaanalysis. Nutr Res. 2016; 36:499-508.
Bednarska-Makaruk M, Graban A, Sobczyńska-Malefora A et al. Homocysteine metabolism and the associations of global DNA methylation with selected gene polymorphismsand nutritional factors in patients with dementia. Exp Gerontol. 2016;81:83-91.
Wong KA, Sahai A, Patel A, Thomas K, Bultitude M, Glass J. Is percutaneous nephrolithotomy in solitary kidneys safe?. Urology. 2013; 82:1013-16.
El-Tabey NA, El-Nahas AR, Eraky I et al. Long-term functional outcome of percutaneous nephrolithotomy in solitary kidney. Urology. 2014; 83:1011-15.
Wu CC, Zheng CM, Lin YF, Lo L, Liao MT, Lu KC. Role of homocysteine in end-stage renal disease. Clin Biochem. 2012; 45:1286-94.
DOI: http://dx.doi.org/10.22037/uj.v0i0.3917
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