Analysis Of The Efficacy Of Tadalafil In Reducing Renal Injury Before Partial Nephrectomy

Objective:In order to optimize the treatment scheme of partial nephrectomy in the future clinical work,and minimize the renal injury related to nephron sparing surgery(NS S),we try to investigate whether pretreatment with tadalafil can attenuate renal injury during NSS.Through monitoring the changes of urinary biomarkers related to renal injury,we try to explore the concrete damaged tissue inside kidney caused by NSS,and to speculate the possible mechanism of renal protective effect of tadalafil.Method:We executed a minimization randomized,controlled,double-blind experiment.A total of 36 patients diagnosed as renal masses were enrolled,both the experimental group and the control group are 18 cases.The test group was given a 20mg tadalafil tablet orally one night before NSS surgery,and the control group was given a tadalafil simulation tablet as placebo.The urine sample was collected prior to surgery and 8h,24h,48h,72h after the operation to monitor the urinary NGAL level.Besides,the urine was also collected before operation and 1,2,3 days after operation to detect changes of urine ?-microglobulin,urine ?-microglobulin,transferrin(TRF),and N-acetyl-?-galactosidase(NAG).The blood samples were collected to detect the levels of serum creatinine and serum cystatin before and 1 day after operation.And the changes of biomarkers related to inflammatory,CRP,ESR,IL-6,was detected before operation and 1,3 days after operation.Through comparing the difference of various outcomes between the experimental group and the control group,conducting a stratified analysis of multiple factors,and comparing the degree of renal damage in different ischemic periods,we try to explore the efficacy and mechanism of tadalafil's reno-protective effect.Results:1.Application of tadalafil before NSS operation can reduce postoperative urine NGAL level(P=0.002);2.Stratified analysis found that there is no difference in urine NGAL levels between the experimental group and the control group of patients without hypertension,age<60 years,laparoscopic surgery(traditional laparoscopy or robot-assisted laparoscopy).3.Preoperative use of tadalafil can reduce inflammation.The postoperative CRP,ESR,and IL-6 levels of the experimental group were significantly lower than those of the control group,with P values of 0.014,0.012,0.003;4.Urinary ?-microglobulin,urinary ?-microglobulin,and NAG levels all increased significantly after NSS operation,but there was no significant difference between the test group and the control group(P=0.259,0.689,0.180).5.Serum creatinine and cystatin did not significantly increase from baseline levels after NSS,and there was no difference between the test group and the control group(P=0.962,0.937)Conclusion:Preoperative application of tadalafil before NSS can significantly reduce postoperative urine NGAL levels.And to those without hypertension,age<60 years,undergoing laparoscopic surgery(traditional or robot-assisted),pretreatment with tadalafil seems to exhibit more benefit.The mechanism of tadalafil attenuating renal injury may involve with inhibiting inflammation.