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. 2009 Oct;104(7):1004-8.
doi: 10.1111/j.1464-410X.2009.08520.x. Epub 2009 Mar 26.

Extracorporeal shock wave lithotripsy at 60 shock waves/min reduces renal injury in a porcine model

Bret A Connors  1 , Andrew P Evan, Philip M Blomgren, Rajash K Handa, Lynn R Willis, Sujuan Gao, James A McAteer, James E Lingeman
Affiliations

Extracorporeal shock wave lithotripsy at 60 shock waves/min reduces renal injury in a porcine model

Bret A Connors et al. BJU Int. 2009 Oct.

Abstract

Objective: To determine if extracorporeal shock wave lithotripsy (ESWL) at 60 shock waves (SWs)/min reduces renal damage and haemodynamic impairment compared to treatment at 120 SWs/min.

Materials and methods: One kidney in each of 19 juvenile pigs (7-8 weeks old) was treated at 120 or at 60 SWs/min (2000 SWs, 24 kV) with an unmodified HM-3 lithotripter (Dornier Medical Systems, Kennesaw, GA, USA). Renal function was determined before and after ESWL treatment by inulin clearance, extraction and clearance of para-aminohippuric acid. Both kidneys were then removed to measure parenchymal lesion size by sectioning the entire kidney and quantifying the size of the haemorrhagic lesion in each slice.

Results: ESWL at 60 SWs/min significantly reduced the size of the acute morphological lesion compared to 120 SWs/min (0.42% vs 3.93% of functional renal volume, P = 0.011) and blunted the decrease in glomerular filtration rate and renal plasma flow normally seen after treatment at 120 SWs/min.

Conclusions: Treatment at a firing rate of 60 SWs/min produces less morphological injury and causes less alteration in renal haemodynamics than treatment at 120 SWs/min in the pig model of ESWL-induced renal injury.

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Figures

FIG. 1
FIG. 1
Representative cross-sections from pig kidneys treated at 120 or 60 SWs/min (2000 SWs, 24 kV) with an unmodified Dornier HM-3 lithotripter. The lesions have been coloured (red) to visualize regions of hemorrhage. Quantitation of the lesion was restricted to the renal parenchyma and did not include areas of bleeding into the renal pelvis, seen here as black deposits in the renal pelvicalyceal system. One papilla is marked with an asterisk (*). Damage to the kidney treated at 120 SWs/min involves several renal papillae and extends from the medulla to the cortex. The subcapsular hematoma in this kidney is beyond the plane of section. The lesion in the kidney treated at 60 SWs/min is restricted to small foci in the medulla (arrows).
FIG. 2
FIG. 2
Effect of 2000 SWs at 120 or 60 SWs/min with an unmodified Dornier HM-3 lithotripter on lesion size (percent functional renal volume). The data are expressed as mean ± SEM. N indicates the number of individual kidneys sectioned and quantified in each group. The ampersand (#) indicates a significant difference between the groups.
FIG. 3
FIG. 3
Effect of 2000 SWs at 120 or 60 SWs/min on glomerular filtration rate. N indicates the number of animals in each group. The asterisks (*) indicates that renal function after ESWL was significantly different in that group from pre-ESWL baseline values. The Ampersand (#) indicates that the two groups were significantly different 1 hour after ESWL.
FIG. 4
FIG. 4
Effect of 2000 SWs at 120 or 60 SWs/min on EPAH. N indicates the number of animals in each group. The asterisks (*) indicates that renal function was significantly different after ESWL in that group from pre-ESWL baseline values. The two groups were not significantly different from each other 1 hour after ESWL.
FIG. 5
FIG. 5
Effect of 2000 SWs at 120 or 60 SWs/min on renal plasma flow. N indicates the number of animals in each group. The asterisks (*) indicates that renal function after ESWL was significantly different in that group from pre-ESWL baseline values. The ampersand (#) indicates that the two groups were significantly different 1 hour after ESWL.
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References

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