Predictor biomarkers for acute kidney injury following Extracorporeal Shockwave Lithotripsy A systematic review

ABSTRACT Introduction: Extracorporeal shockwave lithotripsy (ESWL) has shown to induce acute kidney injury due to vascular and tissue damage. As real-time glomerular filtration rate is not available in developing countries, promising biomarkers are needed to prevent further tubular kidney damage. Methods: This systematic review design follows the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions guidelines. With the keyword of acute kidney injury biomarkers following ESWL, all articles in Medline and Pubmed are analysed for inclusion in this systematic review. Results: There was serum creatinine (SCr), cystatin C (Cys C), kidney injury molecule-1 (KIM-1), N-acetyl-?-D-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and homocysteine that have been studied in acute kidney injury following ESWL. Post-ESWL, SCr increased 0.26-fold (p = 0.006), Cys C has area under the curve (AUC) of 0.49, KIM-1 increased 3-fold (p <0.05), NAG increased 4-5 fold, homocysteine increased by 4.9-fold (P = 0.036), NGAL increased by 0.2-fold (p> 0.05). Moreover, IL-18 increased post- ESWL mainly on slower shockwave. Discussion: It has shown that the potential acute kidney injury biomarker following ESWL including SCr, KIM-1, homocysteine, and NAG. However, as mentioned above, SCr and homocysteine have the high possibility of bias due to the presence of other diseases. KIM-1 and NAG urine could be promising biomarkers as both biomarkers increased significantly in an early stage. Conclusion: From many biomarkers studied following ESWL, KIM-1 and NAG were seemed to be the most potential biomarkers compared to others. KEYWORDS biomarker, ESWL, acute kidney injury