Shock wave lithotripsy-induced renal injury

Abstract

Both clinical and experimental reports clearly show that shock wave lithotripsy (SWL) causes acute renal effects in a majority, if not all, treated kidneys. SWL-induced acute renal damage may result in severe injury to the nephron, microvasculature, and the surrounding interstitium. In addition, at least three chronic adverse effects have been identified when shock waves are administered at a therapeutic dose. These include (1) an accelerated rise in arterial blood pressure, (2) a decrease in renal function, and (3) an increased rate of stone recurrence. The clinical and experimental data that document tissue injury as a result of shock wave treatment are compelling, but have not allowed us to determine the factors responsible for the adverse acute side effects or to identify conditions that may predispose a patient to serious long-term health problems. Thus, there is an urgent need for incisive, fundamental experimental studies to establish the safe limits for shock wave delivery. To accomplish this goal, animal experimentation is required so that the time course and severity of acute and chronic alterations can be followed in a model that closely mimics human renal structure and functions. The minipig provides this model.