Böbrek taşı hastalarda ESWL’ ye bağlı renal hasar üzerine nar suyunun önleyici etkisi

Year 2022, Volume: 17 Issue: 1, 22 - 30, 23.02.2022

Selim Taş , Volkan Tuğcu , Serdar Karadağ , Selçuk Şahin

https://doi.org/10.33719/yud.2022;17-1-973916

Abstract

Amaç: Böbrek taşı tanısı nedeni ile ekstrakorporeal şok dalga litotripsi (ESWL) tedavisi uygulanan hastalarda, ESWL’nin neden olduğu oksidatif stresin yarattığı böbrek hasarının; nar suyunun (NS) antioksidan etkisiyle tedaviye bağlı böbrek hasarına karşı koruyucu etkisi olup olmadığını göstermeyi amaçladık.
Gereç ve Yöntemler: Böbrek taşı nedeniyle ESWL uygulanacak 90 hasta çalışmaya dahil edildi ve 30 kişiden oluşan 3 gruba ayrıldı. Grup 1’deki (kontrol grubu) hastalara sadece ESWL tedavisi uygulandı. Grup 2’deki (çalışma grubu) hastalara ESWL’den 2 gün önce 30 ml/kg/gün hazırlanan nar suyu karışımı 2 gün oral alınması önerildi. Grup 3’teki (plasebo grubu) hastalara ESWL’den 2 gün önce 30 mg/kg/gün su oral alınması önerildi. Hastalara 18-24 kV aralığında 2000-2500 atış yapıldı. Oksidatif stres, DNA lezyonunu gösteren lipid peroksidasyonun belirteçleri ve ESWL’den sonra tübüler hasar göstermek amacı ile her üç gruptaki hastalardan ESWL’den 3 gün önce ve hemen sonra 24 saatlik idrar toplandı ve spot idrar numunesi alındı.
Bulgular: Grup 1’de tedavi sonrası 8-Hydroxy deoxyguanosine (8-OHdG) düzeylerinde ortalama 52,39± 10,49 düzeyinde artış gözlendi (p<0,01). Grup 2’de tedavi sonrası 8-OHdG düzeylerinde ortalama 13,16±7,71 düzeyinde artış gözlendi (p<0,01).
Grup 1’de tedavi sonrası N-acetyl-beta-D-glucosaminidase (NAG) düzeylerinde görülen ortalama l9,20±5,21 düzeyinde artış gözlendi (p<0,01).Grup 2’de tedavi sonrası NAG düzeylerinde ortalama 3,44±5,21 düzeyinde artış gözlendi(p<0,01).
Sonuç: Çalışmamızda NS’nin ESWL’ye bağlı böbrek hasarı üzerine koruyucu etkisi olduğunu gösterdik.

Keywords

Antioksidan , böbrek taşı , taş kırma , nar suyu

Preventive effect of pomegranate juice on ESWL-related renal damage in patients with kidney stones

Abstract

Objective: We aimed to show whether the antioxidant properties of pomegranate juice (PJ) show a protective effect against renal damage associated with oxidative stress caused by Extracorporeal Shock Wave Lithotripsy (ESWL) in patients who have undergone ESWL for kidney stones. 
Material and Methods: Ninety patients who were to undergo ESWL for kidney stones were included in the study and were divided into 3 groups with 30 patients each ESWL. Group 1 (control group) patients received only ESWL treatment. Group 2 (study group) patients were recommended to take 30 ml/kg/day pomegranate juice mixture orally for 2 days before ESWL. Group 3 (placebo group) patients were recommended to take 30 mg/kg/day water orally for 2 days before ESWL. All ESWL-treated patients received 2000 to 2500 shock waves at 18 to 24 in order to measure lipid peroxidation markers showing the DNA lesion associated with oxidative stress and to show tubular damage after ESWL, 
Results: There was a statistically significant mean increase of 52.39± 10.49 in 8-Hydroxy deoxyguanosine (8-OHdG) levels after treatment compared to pre-treatment levels in Group 1 (p<0.01). There was a statistically significant mean increase of 13.16±7.71 and 33.24±12.82 in Groups 2 and 3, respectively (p<0.01; p<0.01, respectively)
There was a statistically significant mean increase of 19.20±5.21 in N-acetyl-beta-D-glucosaminidase (NAG) levels after treatment compared to pre-treatment levels in Group 1 (p<0.01). There was a statistically significant mean increase of 3.44±5.21 and 13.07±5.50 in Groups 2 and 3, respectively (p<0.01; p<0.01, respectively).
Conclusion: Our study concluded that pomegranate juice (PJ) has protective effects against ESWL-related renal damage.

Keywords

Antioxidant , Kidney stones , Lithotripsy , Pomegranate Juice.

References

• Aksoy Y, Malkoc I, Atmaca A, et al. The effects of extracorporeal shock wave lithotripsy on antioxidant enzymes in erythrocytes. Cell Biochemistry and Function: Cellular biochemistry and its modulation by active agents or disease, 2006; 24(5):467-469.
• Chaussy C,H Walter Brendel, and E Schmiedt. Extracorporeally induced destruction of kidney stones by shock waves. The Lancet 316. 1980;8207:1265-1268.
• Karlsen J, Smevik B., Stenstrom, et al. “Acute physiological changes in canine kidneys following exposure to extracorporeal shock waves.” The Journal of urology. 1990; 143(6):1280-1283.
• Fegan JE, Hausmann DA, Alexander M. Preservation of renal architecture during extracorporeal shock wave lithotripsy. J Endourol. 1991; 5: 273-276.
• Willis RL. Evan AP, Connors BA, et al. Effects of extracorporeal shock wave lithotripsy to one kidney on bilateral glomerular filtration rate and PAH clearance in minipigs. J Urol 1996; 156:1502-1506.
• Kishimoto T, Senju M, Sugimoto T. Effect of high energy shock wave exposure on renal function during extracorporeal shock wave lithotripsy for kidney stones. Eur Urol 1990;18: 290.
• Hirano T, Yamaguchi R, Asami S, et al. Kasai H. 8-Hydroxyguanine levels in nuclear DNA and its repair activity in rat organs associated with age. The Journal of Gerantology 1996;51:303-305.  
• Kasai H. Analysis of a form of oxidative DNA damage, 8-Hydroxy-2’-deoxyguanosine, as a marker of celluler oxidative stress during carcinogensis. Mutation Research. 1997; 387:147-63. T Vögeli, B Schmitz-Dräger, HE Mellin, et al. “Changes in Erythropoietin Serum Levels by Extracorporeal Shock Wave Lithotripsy.” Urologia internationalis. 1990; 45(2):92-94.
• Rice.E, Catherine A, Nicholas J, et al. Structure-antioxidant activity relationships of flavonoids and phenolic acids. Free radical biology and medicine 1996; 20(7):933-956.
• Rosenblat M, Volkova N, Coleman R, et al. Pomegranate byproduct administration to apolipoprotein edeficient mice attenuates atherosclerosis development as a result of decreased macrophage oxidative stress and reduced cellular uptake of oxidized low-density lipoprotein. J Agric Food Chem. 2006; 54:1928-1935.
• Kaur G, Jabbar Z, Athar M, et al. Punica granatum (pomegranate) flower extract possesses potent antioxidant activity and abrogates Fe-NTA induced hepatotoxicity in mice. Food Chem Toxicol. 2006; 44:984-993.
• Faria A, Monteiro R, Mateus N ,et al. Effect of pomegranate (Punica granatum) juice intake on hepatic oxidative stress. Eur J Nutr. 2007; 46:271-278.
• Kaur G, Jabbar Z, Athar M, et al. Punica granatum (pomegranate) flower extract possesses potent antioxidant activity and abrogates Fe-NTA induced hepatotoxicity in mice. Food Chem Toxicol. 2006; 44: 984-993.
• Rosenblat M, Hayek T, Aviram M. Anti-oxidative effects of pomegranate juice (PJ) consumption by diabetic patients on serum and on macrophages. Atherosclerosis 2006; 187: 363-371.
• Aviram M, Domfeld L, Rosenblat M, et al. Pomegranate juice consumption reduces oxidative stress, atherogenic modifications to LDL, and platelet aggregation: studies in humans and in atherosclerotik apolipoprotein E-deficient mice. Am J Clin Nurt. 2000; 71:1062-76.  
• Evan, A. P. Willis, L. R., Lingeman, et al. Renal trauma and the risk of long-term complications in shock wave lithotripsy. Nephron 1998; 78(1):1-8.
• Fegan JE, Hausmann DA, Alexander M. Preservation of renal architecture during extracorporeal shock wave lithotripsy. J Endourol 1991; 5:273-276.
• E Rhoden, C Telöken, M Lucas Rhoden, Ernani, et al. Protective effect of allopurinol in the renal ischemia–reperfusion in uninephrectomized rats. General Pharmacology: The Vascular System 2000; 35(4):189-193.
• Serel TA, Özgüner F, Soyupek S. Prevention of shock wave induced renal oxidative stres by melatonin: an experimental stuyd. Urol Res. 2004; 32:69-71.
• Tugcu V, Kemahli E, Ozbek E, et al. Protective effect of a potent antioxidant, pomegranate juice, in the kidney of rats with nephrolithiasis induced by ethylene glycol. Journal of Endourology 2008; 22(12):2723-2732.
• Hinokio Y, Suziki S, Chiba M, et al. Oxidative DNA damage in diabetes mellitus: its association with diabetic complications. Diabetologia. 1999; 42(8):995-8.
• Biri H,Ozturk HS, Buyukkoçak S, et al. Antioxidant defense potential of rabbit renal tissue after ESWL: proctective effects of antioxidant vitamins. Nefron. 1998; 79:181-185.
• Ozguner F, Armağan A, Koyu A, et al. A novel antioxidant agent caffeic asid phenethyl ester prevents shock wave-induced renal tubuler oxidative sters. Urol Res. 2005; 33:239-243.
• Eterović D, Šitum M. Punda A et al. “Urinary obstruction depresses erythropoiesis which recovers after parenchyma-saving surgery but not SWL.” Urological research 2010; 38(1):51-56.
• Wıllıs L, R Evan A, P Connors et al. Effects of extracorporeal shock wave lithotripsy to one kidney on bilateral glomerular filtration rate and PAH clearance in minipigs. The Journal of urology, 1996, 156.4: 1502-1506.