Clinical value of urinary sediment plus urinary markers in the diagnosis of renal injury after percutaneous nephrolithotripsy

Objective To explore the clinical value of urinary sediment plus urinary markers in the diagnosis of renal injury after percutaneous nephrolithotomy.Methods From June 2018 to February2021,a total of 168 patients with renal calculi were recruited for percutaneous nephrolithotomy. Blood and urinary biochemical parameters were measured and urine sediment microscopic examinations conducted.They were divided into two groups of injury and uninjured according to whether or not renal injury occurred postoperatively. Multivariate Logistic regression was utilized for examining the risk factors of postoperative renal injury. Receiver operating characteristic curve(ROC)was employed for analyzing the diagnostic value of each index for postoperative renal injury.Results The preoperative blood creatinine level(123.76±22.72) μmol/L vs(92.62±17.53) μmol/L,preoperative urinary sediment score(0.67±0.17)vs(0.54±0.13)and urinary β2-microglobulin(β2-MG)(156.57±31.59)μg/L vs(140.14±29.27)μg/L,neutrophil gelatinase associated lipocalin(NGAL)(62.57±10.59)μg/L vs(50.14±9.43)μg/Land lactic dehydrogenase(LDH)(86.57±15.59)U/L vs(76.14±11.27)U/Lwere significantly higher in injury group than those in uninjured group(P<0.05). The preoperative urine sediment scores(2.74±0.56 vs 1.36±0.27),urinary β2-MG(252.54±44.29)μg/L vs(174.57±36.58) μg/L,NGAL(152.54±14.59) μg/L vs(64.54±16.59) μg/L and LDH(142.48±21.29)U/L vs(94.57±16.58)U/Lof two groups showed a rising trend after treatment and the changes of injured group were significantly higher than those of uninjured group(P<0.001). Logistic regression analysis showed that preoperative blood creatinine,urinary sediment score,β2-MG,NGAL and LDH(OR=2.540,2.307,1.964,1.702,2.164;95%CI:1.242-5.193,1.223-4.354,1.123-3.434,1.259-2.302,1.216-3.851)were risk factors for postoperative renal injury(P<0.05). AUC of urinary sediment score,β2-MG,NGAL and LDH for diagnosing postoperative renal injury were 0.801,0.827,0.791 and 0.772(95%CI:0.729-0.873,0.751-0.904,0.705-0.878,0.698-0.846),Each was significantly lower than 0.875 of combined diagnosis(95%CI:0.819-0.931). The differences were statistically significant(P<0.05).Conclusion Preoperative urinary sediment score,urine markers(β2-MG,NGAL & LDH)are correlated with renal injury after percutaneous nephrolithotomy. And combined detection may improve the diagnostic efficiency of renal injury.