The Study On Serum And Urine Cys-C And KIM-1 As Markers Of Renal Injury Induced By Unilateral Ureteral Calculi

Objective:To evaluate the efficacy of serum and urine Cystain C (Cys-C) and kidney injury molecule-1 (KIM-1) level in predicting early renal injury induced by ureteral calculi.Methods:The serum creatinine, Cys-C, serum and urine KIM-1 level of 32 patients (range 18-50 years) diagnosed with first onset unilateral ureteral stones were detected on the day before operation and the first day,7 days and 3 months after operation, and those of 20 healthy people were detected as normal values. KIM-1 was analysis by enzyme-linked immunosorbent assay while Cys-C was analysis by immunoturbidimetric assay. The size and location of the stone, degree of hydronephrosis of each patient were recorded. Separate glomerular filtration rate (GFR) was evaluated by 99Tc diethylene triamine penta acetic acid (99Tcm-DTPA) renal dynamic imaging within a week before operation and 3 months after operation. All analyses were performed by using SPSS 13.0.Results:The serum and urine KIM-1 level of preoperative and postoperative samples from the stone patients were significantly higher than those of normal people (P<0.01). The serum and urine level of KIM-1 decreased gradually after ureteral stones removed, but at 3 months after operation they were still higher than normal values (P<0.01). There was no significant statistical difference in the serum Cys-C and serum creatinine level between stone patients and normal people (P>0.05). The serum and urine KIM-1 level were positively correlated with the degree of hydronephrosis (r=0.755,0.750, respectively, P<0.01), even those of patients with mild hydronephrosis were higher than normal values(P<0.01).No significant correlation between serum and urine KIM-1 level with the size and location of the stones was found(P>0.05). The serum and urine KIM-1 level were positively correlated with the decreased GFR of the affected kidney (counted as the value of the difference of bilateral GFR) within a week before operation and at 3 months after operation (r=0.663,0.659, respectively, P<0.01). The serum and urine KIM-1 level were negatively correlated with the GFR of the affected kidney within a week before operation and at 3 months after operation(P <0.01). The degree of hydronephrosis was negatively correlated with the GFR of the affected kidney within a week before operation and at 3 months after operation (r=-0.511,-0.497, respectively, P<0.01).There was no significant correlation between the size and location of the stones with the GFR of the affected kidney (P>0.05).Conclusions:The serum and urine KIM-1 level of the patients with unilateral ureteral stones were higher than those of healthy people, and decreased gradually within 3 months after ureteral stones removed. The preoperative serum and urine KIM-1 level may play a role in predicting the decline of the GFR of the affected kidney, and may be potential diagnosing markers of early renal injury which can help determine the treatment program and the time of operation for unilateral ureteral calculi in clinical practice.