BACKGROUND: Shockwave lithotripsy (SWL) is considered to be a “gold standard" for treatment of kidney stones in children. Despite its minimal invasiveness SWL is known to cause acute renal damage. The aim of the study was to evaluate the efficacy of prednisolone nephroprotection.METHODS: From January 2022 till October 2023 a total of 108 stone patients were treated with SWL. 54 of them comprised a control group and 54 were treated with prednisolone (0,5 mg/kg.) twice: 2 days and 2 hours before SWL . We sampled acute kidney injury biomarkers concentration in urine (neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), tissue inhibitor of metalloproteinase-2 (TIMP-2) and in serum (interleukin-18 (IL-18)) before SWL (point 1), 45 minutes after (point 2) and 24 hours after (point 3) the procedure.RESULTS: All biomarkers showed a significant increase after SWL. The highest concentrations of biomarkers were recorded at point 2 and for interleukin-18 - at point 3. NGAL level at point 2 in control group was 48.3 (24.5; 117.0) ng/mL - significantly higher (p=0.044) than in treatment group - 28.4 (16.0; 71.8) ng/mL. KIM-1 concentration at point 2 in control group was 0.57 (0.45; 0.70) ng/mL. and in treatment group 0.48 (0.25; 0.91) ng/mL, which was not statistically different (p=0.344). TIMP-2 level at point 2 in control group (12.3 (9.23;20.2) ng/mL) was significantly higher (p<0.001) than in treatment group (6.75 (5.2; 12.1) ng/mL.). IL-18 level at point 3 in control group (164.7 (113.7; 217.1) pg/mL) was significantly higher (p=0.042), than in treatment group (130.3 (89.7;186.1) pg/mL). CONCLUSIONS: We identified highly sensitive biomarkers for SWL-induced acute kidney injury and assessed their level changes in prednisolone treatment setting. According to our data prednisolone is effective for acute kidney injury prophylaxis during SWL in children.
