Retrograd intrarenal cerrahi uygulanan hastalarda R.I.R.S. skorlama sisteminin postoperatif akut böbrek hasarı ile ilişkisi
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Tarih
2024
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Üriner sistem taş hastalığı günümüzde sıklıkla karşılaşılan ve görülme sıklığı giderek artan bir sağlık problemidir. Gelişen teknoloji ile birlikte retrograd intrarenal cerrahi (RIRS) böbrek taşı tedavisinde giderek önem kazanmıştır. RIRS sonrası başarı ve taşsızlık oranlarını değerlendirmek için çeşitli skorlama sistemleri ve nomogramlar geliştirilmiştir. R.I.R.S. skorlama sistemi, RIRS sonrası taşsızlığı öngörmede önemli yer tutmaktadır. RIRS sonrası ciddi postoperatif komplikasyonlar meydana gelebilir. Bu komplikasyonlardan birisi de akut böbrek hasarıdır. İskemik ve nefrotoksik akut böbrek hasarını belirlemek için tip-1 transmembran glikoproteini olan Kidney Injury Molecule-1(KIM-1) gibi biyobelirteçler kullanılmaktadır. İdrar KIM-1 düzeylerinin serum kreatinini ve idrar çıkışından önce tubüler, interstisyel ve glomerüler hasarda arttığı ve böbrek hasarının şiddeti ile ilişkili olduğu bilinmektedir. Çalışmamızda RIRS yapılan hastalarda R.I.R.S. skorlama sisteminin postoperatif akut böbrek hasarı ile ilişkisinin idrar Kidney Injury Molecule-1 (KIM-1) biyobelirteç değerleri ölçülerek araştırılması amaçlanmıştır.
Materyal Metod: Kliniğimizde 01.08.2023 ile 01.02.2024 tarihleri arasında böbrek taşı nedeni ile RIRS yapılan 18-65 yaş arası 60 yetişkin hasta çalışmaya dahil edildi ve prospektif olarak değerlendirildi. Hastaların demografik verileri, ameliyat süresi ve ameliyat sonrası hastanede kalış süreleri ve postoperatif komplikasyonlar kaydedilmiştir. Preoperatif çekilmiş olan bilgisayarlı tomografide taş boyutları, taşın dansitesi (Houndsfield Ünitesi [HU]), lokalizasyonu ve infundibulopelvik açılar incelenerek her hastanın R.I.R.S. skorları hesaplanmıştır. Ayrıca taşsızlığı öngören diğer skorlama sistemleri [Reşorlu-Ünsal Taş Skoru. (RUSS), Modifiye Seul Ulusal Üniversitesi Böbrek Taş Kompleksi Skoru (S-ReSC)] de hesaplanarak bu skorlama sistemlerinin ROC analizi ile taşsızlığı öngörebilme yetenekleri incelenip karşılaştırılmıştır. Hastalardan operasyon öncesinde ve operasyon sonrası 4. ve 24. saatlerde olmak üzere alınan idrar örneklerindeki KIM-1 düzeyleri ELISA yöntemiyle analiz edilmiştir. Operasyon sonrası KIM-1/Cr değerlerindeki değişiklikler hesaplanmıştır. Hastalar
için belirlenmiş olan R.I.R.S. skoru ile KİM-1/Cr düzeylerindeki değişiklikler arasındaki ilişki için Pearson korelasyon analizi yapılmıştır ve sonuçlar değerlendirilmiştir.
Bulgular: Ortalama hasta yaşı 53.4 (19-64) yıl, ortalama taş boyutu 15.5±6.5 mm idi. Ortalama operasyon süresi 58.3±25.9 dk olup hastaların ortalama R.I.R.S, RUSS ve Modifiye S-ReSC skorları sırasıyla 6.3 (4–10), 0.8 (0-3) ve 1.5 (1–3) idi. Postoperatif taşsızlık oranı %86.7 idi. R.I.R.S. skorlama sisteminin postoperatif taşsızlığı öngörmede diğer iki skorlama sistemine göre daha yüksek prediktif değere sahip olduğu görüldü (AUC = 0.894, %95 CI, 0.805-0.985, p < 0.001). Hastaların preoperatif, postoperatif 4. saat ve postoperatif 24. saat ortalama idrar KIM-1/Cr düzeyleri sırasıyla 0.40, 1.73 ve 1.15 olarak bulundu ve istatistiksel olarak aralarında anlamlı fark görüldü (p<0,001). Postoperatif 4. Saat idrar KIM-1/Cr yükseliş düzeyi ortalama 1.32 (0.5-1.9) olarak saptandı. Yapılan Pearson korelasyon analizinde hastaların R.I.R.S. skorları ile; postoperatif 4. saatteki idrar KIM-1/Cr yükseliş düzeyleri arasında ve postoperatif 4. saat idrar KIM-1/Cr düzeyleri arasında pozitif korelasyon olduğu görüldü (sırasıyla r = 508, p<0.001; r = 0.477, p<0.001).
Sonuç: R.I.R.S. skorlama sistemi, RIRS yapılan hastalarda postoperatif taşsızlığı öngörmesinin yanı sıra postoperatif gelişebilecek olan akut böbrek hasarı hakkında da bilgi verebilir.
Introduction: Urinary tract stone disease is a common health problem and its prevalence is increasing. With advancing technology, retrograde intrarenal surgery (RIRS) has gained importance in kidney stone treatment. Various scoring systems and nomograms have been developed to evaluate the success and stone-free rates after RIRS. The R.I.R.S. scoring system plays an important role in predicting stone-free status after RIRS. Serious postoperative complications might occur after RIRS. One of which those complications is acute kidney injury. Biomarkers such as Kidney Injury Molecule-1 (KIM-1), which is a type-1 transmembrane glycoprotein, are used to identify ischemic and nephrotoxic acute kidney injury. The urinary KIM-1 levels increase in tubular, interstitial and glomerular damage before serum creatinine and urine output, and are associated with the severity of kidney injury. In our study, we aimed to investigate the relationship between the R.I.R.S. scoring system and postoperative acute kidney injury in patients undergoing RIRS by measuring urinary Kidney Injury Molecule-1 (KIM-1) biomarker levels. Materials and Methods: A total of 60 patients aged 18-65 years who underwent RIRS for kidney stones between 01.08.2023 and 01.02.2024 in our clinic were included in the study and prospectively evaluated. Demographic data, operation time, postoperative hospital stay, and postoperative complications of the patients were recorded. Stone size, stone density (Hounsfield Units [HU]), localization and infundibulopelvic angles were evaluated using preoperatively obtained computed tomography and R.I.R.S. scores were calculated for each patient. In addition, other scoring systems predicting stone-free status (Reşorlu-Ünsal Stone Score (RUSS), Modified Seoul National University Kidney Stone Complex Score (S-ReSC)) were also calculated and the ability of these scoring systems to predict stone-free status was investigated and compared using ROC analysis. KIM-1 levels in urine samples taken from patients before surgery and on the 4th and 24th hours after surgery were analyzed by ELISA method. Changes in postoperative KIM-1/Cr values were calculated. Pearson correlation analysis was performed to evaluate the relationship between the determined R.I.R.S. score for the patients and the changes in urine KIM-1/Cr levels. Results: Mean patient age was 53.4 (19-64) years and mean stone size was 15.5±6.5 mm. Mean operation time was 58.3±25.9 minutes and mean R.I.R.S, RUSS and Modified S-ReSC scores of the patients were 6.3 (4–10), 0.8 (0-3) and 1.5 (1–3), respectively. The postoperative stone-free rate was 86.7%. The R.I.R.S. scoring system was found to have a higher predictive value than the other two scoring systems in predicting postoperative stone-free status (AUC = 0.894, 95% CI, 0.805-0.985, p < 0.001). The mean urinary KIM-1/Cr levels of the patients were 0.40, 1.73 and 1.15 preoperatively, postoperatively at 4th hour and postoperatively at 24th hour, respectively, and there was a statistically significant difference between them (p < 0.001). The mean postoperative 4th hour urinary KIM-1/Cr rise level was determined as 1.32 (0.5-1.9). In the Pearson correlation analysis, it was seen that there was a significant positive correlation between R.I.R.S scores and postoperative 4th hour urine KIM-1/Cr elevation levels (r = 0.508, p<0.001). Additionally, a significant positive correlation was found between R.I.R.S scores and postoperative 4th hour urine KIM-1/Cr levels (r = 0.477, p<0.001). Conclusion: The R.I.R.S. scoring system can not only predict postoperative stone-free status in patients undergoing RIRS, but also provide information about potential postoperative acute kidney injury.
Introduction: Urinary tract stone disease is a common health problem and its prevalence is increasing. With advancing technology, retrograde intrarenal surgery (RIRS) has gained importance in kidney stone treatment. Various scoring systems and nomograms have been developed to evaluate the success and stone-free rates after RIRS. The R.I.R.S. scoring system plays an important role in predicting stone-free status after RIRS. Serious postoperative complications might occur after RIRS. One of which those complications is acute kidney injury. Biomarkers such as Kidney Injury Molecule-1 (KIM-1), which is a type-1 transmembrane glycoprotein, are used to identify ischemic and nephrotoxic acute kidney injury. The urinary KIM-1 levels increase in tubular, interstitial and glomerular damage before serum creatinine and urine output, and are associated with the severity of kidney injury. In our study, we aimed to investigate the relationship between the R.I.R.S. scoring system and postoperative acute kidney injury in patients undergoing RIRS by measuring urinary Kidney Injury Molecule-1 (KIM-1) biomarker levels. Materials and Methods: A total of 60 patients aged 18-65 years who underwent RIRS for kidney stones between 01.08.2023 and 01.02.2024 in our clinic were included in the study and prospectively evaluated. Demographic data, operation time, postoperative hospital stay, and postoperative complications of the patients were recorded. Stone size, stone density (Hounsfield Units [HU]), localization and infundibulopelvic angles were evaluated using preoperatively obtained computed tomography and R.I.R.S. scores were calculated for each patient. In addition, other scoring systems predicting stone-free status (Reşorlu-Ünsal Stone Score (RUSS), Modified Seoul National University Kidney Stone Complex Score (S-ReSC)) were also calculated and the ability of these scoring systems to predict stone-free status was investigated and compared using ROC analysis. KIM-1 levels in urine samples taken from patients before surgery and on the 4th and 24th hours after surgery were analyzed by ELISA method. Changes in postoperative KIM-1/Cr values were calculated. Pearson correlation analysis was performed to evaluate the relationship between the determined R.I.R.S. score for the patients and the changes in urine KIM-1/Cr levels. Results: Mean patient age was 53.4 (19-64) years and mean stone size was 15.5±6.5 mm. Mean operation time was 58.3±25.9 minutes and mean R.I.R.S, RUSS and Modified S-ReSC scores of the patients were 6.3 (4–10), 0.8 (0-3) and 1.5 (1–3), respectively. The postoperative stone-free rate was 86.7%. The R.I.R.S. scoring system was found to have a higher predictive value than the other two scoring systems in predicting postoperative stone-free status (AUC = 0.894, 95% CI, 0.805-0.985, p < 0.001). The mean urinary KIM-1/Cr levels of the patients were 0.40, 1.73 and 1.15 preoperatively, postoperatively at 4th hour and postoperatively at 24th hour, respectively, and there was a statistically significant difference between them (p < 0.001). The mean postoperative 4th hour urinary KIM-1/Cr rise level was determined as 1.32 (0.5-1.9). In the Pearson correlation analysis, it was seen that there was a significant positive correlation between R.I.R.S scores and postoperative 4th hour urine KIM-1/Cr elevation levels (r = 0.508, p<0.001). Additionally, a significant positive correlation was found between R.I.R.S scores and postoperative 4th hour urine KIM-1/Cr levels (r = 0.477, p<0.001). Conclusion: The R.I.R.S. scoring system can not only predict postoperative stone-free status in patients undergoing RIRS, but also provide information about potential postoperative acute kidney injury.
Açıklama
Anahtar Kelimeler
Akut Böbrek Hasarı, Böbrek Taşı, KİM-1 molekülü, Retrograd İntrarenal Cerrahi, R.I.R.S. Skorlama Sistemi, Acute Kidney Injury, Kidney Stone, KIM-1 Molecule, Retrograde Intrarenal Surgery, R.I.R.S. Scoring System
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Altınkaya, N. (2024). Retrograd intrarenal cerrahi uygulanan hastalarda R.I.R.S. skorlama sisteminin postoperatif akut böbrek hasarı ile ilişkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Üroloji Anabilim Dalı, Konya.
