A Pilot Study to Evaluate Haemostatic Function, following Shock Wave Lithotripsy (SWL) for the Treatment of Solitary Kidney Stones

Abstract

PurposeThe number of patients undergoing shock wave lithotripsy (SWL) in the UK for solitary unilateral kidney stones is increasing annually. The development of postoperative complications such as haematuria and sepsis following SWL is likely to increase. Comparing a range of biological markers with the aim of monitoring or predicting postoperative complications following SWL has not been extensively researched. The main purpose of this pilot-study was to test the hypothesis that SWL results in changes to haemostatic function. Subsequently, this pilot-study would form a sound basis to undertake future investigations involving larger cohorts.MethodsTwelve patients undergoing SWL for solitary unilateral kidney stones were recruited. From patients (8 male and 4 females) aged between 31–72 years (median—43 years), venous blood samples were collected pre-operatively (baseline), at 30, 120 and 240 minutes postoperatively. Specific haemostatic biomarkers [platelet counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, von Willebrand Factor (vWF), sE-selectin and plasma viscosity (PV)] were measured.ResultsPlatelet counts and fibrinogen concentration were significantly decreased following SWL (p = 0.027 and p = 0.014 respectively), while D-dimer and vWF levels significantly increased following SWL (p = 0.019 and p = 0.001 respectively). PT, APTT, sE-selectin and PV parameters were not significantly changed following SWL (p>0.05).ConclusionsChanges to specific biomarkers such as plasma fibrinogen and vWF suggest that these represent a more clinically relevant assessment of the extent of haemostatic involvement following SWL. Analysis of such markers, in the future, may potentially provide valuable data on “normal” response after lithotripsy, and could be expanded to identify or predict those patients at risk of coagulopathy following SWL. The validation and reliability will be assessed through the assessment of larger cohorts.

Evaluation of hemostasis parameters and the role of the oxidative damage to plasma proteins in the modulation of hemostasis in patients with nephrolithiasis before and after extracorporeal shock wave lithotripsy

“…D-dimer concentration, in nephrolithiasis patients following ESWL, compared to healthy subjects and patients undergoing ESWL. These observations were similar to those of Umekawa et al [ 2 ] and Hughes et al [ 3 ]. Umekawa et al [ 2 ] report a correlation between fibrin degradation products (FDP) and D-dimer concentration following SWL.…”

“…Interestingly, our present findings do not include any significant changes in PT, TT or APTT in patients with nephrolithiasis, either before or after ESWL. Other authors [ 3 ] describe the same observations for PT and APPT in patients after SWL.…”

“…A few papers indicate that patients with nephrolithiasis are at increased risk of hemostatic complications, especially increased risk of coagulopathy, following SWL [ 2 , 3 ]. However, the pathogenesis of hemostasis in patients with nephrolithiasis, particularly after forms of treatment such as SWL, is not completely understood.…”

“…Blood platelets are also very important element of hemostasis. Some papers note the presence of various hemostatic complications are observed in patients with nephrolithiasis after extracorporeal shock wave lithotripsy (ESWL) [ 2 , 3 ]. Moreover, other complications associated with ESWL (i.e.…”

“…surgery and Flexible Ureterorenoscopy) for treatment of kidney stones also have effect on changes in hemostasis [ 4 , 5 ]. Hughes et al [ 3 ] report changes in the levels of specific biomarkers of hemostasis, i.e. plasma fibrinogen, in patients after shock wave lithotripsy (SWL); however, the effect of SWL was measured on hemostasis parameters 30–240 minutes after SWL treatment.…”