COMPARATIVE EFFICACY OF NEPHROPROTECTIVE AGENTS IN CHRONIC KIDNEY DISEASE WITH UROLOGICAL COMORBIDITIES

Abstract

Chronic Kidney Disease (CKD) complicated by urological comorbidities presents a complex clinical challenge, as impaired renal function is often exacerbated by recurrent obstruction, infection, or structural abnormalities of the urinary tract. This comparative study evaluated the therapeutic effects of ACE inhibitors, SGLT2 inhibitors, and antioxidant therapy across a 24-week intervention period in patients with CKD stages 2–4. Quantitative analyses revealed significant improvements in renal functional markers—including serum creatinine, eGFR, and albuminuria—with SGLT2 inhibitors demonstrating the greatest nephroprotective effect, particularly in patients with recurrent obstructive pathology or metabolic stone disease. Antioxidant therapy showed moderate yet consistent benefits in reducing oxidative stress–associated markers such as NGAL, KIM-1, and IL-18, while ACE inhibitors remained effective in stabilizing glomerular hemodynamics but produced comparatively smaller reductions in biomarker indices. Correlation analyses indicated strong inverse relationships between eGFR and NGAL, suggesting that biomarker-based monitoring can enhance early detection of subclinical injury in CKD patients with urological complications. Additionally, reductions in urological complication rates—such as stone recurrence, urinary retention, or reflux episodes—were more prominent in the SGLT2 inhibitor group, highlighting secondary benefits beyond renal filtration. Overall, the findings demonstrate that nephroprotective strategies must be tailored not only to renal stage but also to associated urological pathology to optimize clinical outcomes. This study reinforces the need for integrated nephrology-urology therapeutic models to improve long-term renal preservation and reduce progression to end-stage kidney disease.