Relationship between Kidney Size, Renal Injury, and Renal Impairment Induced by Shock Wave Lithotripsy

Abstract

Abstract. The relationship between kidney size and impaired renal function induced by shock-wave lithotripsy (SWL) was examined in 6- and 10-wk-old anesthetized pigs. Each pig received 2000 shock waves, 24 kV, or sham SWL to the lower pole calyx of one kidney. Bilateral GFR, renal plasma flow (RPF), and para-aminohippurate extraction was measured 1 h before and 1 and 4 h after SWL. The kidneys were then removed for morphometric analysis. Mean kidney weights were 66.1 ± 2.7 g (n = 9) and 103.1 ± 3.3 g (n = 8) in the SWL groups, and 60.1 ± 2.6 g (n = 9) and 82.3 ± 4.0 g (n = 9) in the sham-SWL groups. SWL-induced lesions occupied a significantly greater volume of the small kidneys (6.1 ± 1.7 vol % versus 1.5 ± 0.2 vol % in the large kidneys). RPF was significantly reduced by SWL in small and large kidneys, but to a significantly greater extent in small kidneys. RPF was also significantly reduced in the contralateral kidneys of both groups, but only at 1 h after SWL. SWL significantly reduced GFR to similar degrees in both kidneys of both groups, regardless of kidney size. Para-aminohippurate extraction was likewise reduced to similar degrees in both groups, but this effect was evident only in the SWL-treated kidneys, and only in the pole to which the shock waves had been applied. The injury induced by SWL affected a larger fraction of small kidneys than large ones, and the renal vasoconstriction induced by SWL was greatest in small kidneys.

European Association of Urology and European Society for Paediatric Urology Guidelines on Paediatric Urinary Stone Disease

“…Stone-free rates of nearly 90% for stones <1 cm, 80% for 1-2 cm, 60% for >2 cm, and 80% overall have been reported. The need for additional sessions increases with stone size [10][11][12][13][14][15].…”

A meta-analysis: retrograde intrarenal surgery vs. percutaneous nephrolithotomy in children

“…The first treatment choice for most pediatric kidney stones is ESWL ( 20 ). However, ESWL has numerous limitations, including the need for multiple sessions, general anesthesia requirements, and the shock waves' long-term effects on the developing kidney are unknown ( 21 – 23 ). Over the last few years, more minimally invasive surgeries have been frequently utilized as a substitute for the previous ESWL and open surgeries for kidney stones in children, such as PCNL and RIRS ( 24 – 26 ).…”

In vitro evaluation of canine and feline calcium oxalate urolith fragility via shock wave lithotripsy

“…Although it was initially thought that clinical applications of SWL did not cause renal injury, results of recent studies [11][12][13][14][15][16][17][18] indicate that SWL does cause considerable renal injury, the severity of which is dependent on the number and voltage of the applied shock waves. The effects of shock wave treatment on renal function and structure in cats has only been studied in limited numbers of cats that received relatively low doses of shock waves.…”