Removal of Kidney Stones by Extracorporeal Shock Wave Lithotripsy Is Associated with Delayed Progression of Chronic Kidney Disease

Abstract

PurposeThis study aimed to elucidate whether stone removal by extracorporeal shock wave lithotripsy (ESWL) is associated with delayed chronic kidney disease (CKD) progression.Materials and MethodsWe conducted a retrospective analysis of 131 nephrolithiasis patients with stage 3 and 4 CKD. We collected baseline clinical and laboratory data, kidney stone characteristics, and history of receiving ESWL. We classified study patients into two groups according to whether they underwent ESWL or not (Non-ESWL group vs. ESWL group). We initially compared annual estimated glomerular filtration rate (eGFR) changes of Non-ESWL group with those of ESWL group before undergoing ESWL. In the next step, we sought to compare annual eGFR changes in the same patients before and after ESWL. Finally, we compared annual eGFR changes between success and failure groups among patients undergoing ESWL.ResultsThe mean age of the patients was 62 years and 72.5% were male. The mean observation period was 3.2 years. Non-ESWL group and ESWL group before undergoing ESWL showed similar annual eGFR changes (-1.75±6.5 vs. -1.63±7.2 mL/min/1.73 m2/year, p=0.425). However, eGFR declined slower after undergoing ESWL than before ESWL (annual eGFR changes, -0.29±6.1 vs. -1.63±7.2 mL/min/1.73 m2/year, p<0.05). In addition, among patients in ESWL group, eGFR declined faster in the failure group than in the success group (annual eGFR change, -1.01±4.7 vs. -0.05±5.2 mL/min/1.73 m2/year, p<0.05).ConclusionOur results suggest that stone removal by ESWL is associated with delayed deterioration of renal function in CKD patients with nephrolithiasis.

Shock Wave Lithotripsy Does Not Impair Renal Function in a Swine Model of Metabolic Syndrome

“…17 A 19-year follow-up retrospective study of 288 patients found that the rate of renal insufficiency (*5%) was unchanged after SWL despite higher rates of obesity and diabetes. 23 In contrast, a 15-month follow-up prospective study on 134 patients reported that SWL was associated with a higher prevalence of CKD after treatment, and that BMI was a risk factor for CKD after SWL.…”

“…14,15 The few reports addressing the long-term outcome of SWL in stone patients with chronic renal insufficiency would also suggest that SWL is safe in such a vulnerable cohort. [15][16][17] The etiology of CKD in these patients is thought to be obstructive uropathy with SWL treatment providing relief from obstruction and generally improving renal function. However, there is limited information on whether SWL treatment may exacerbate the risk for renal functional impairment in patients with MetS-obesity, hypertension, insulin resistance, and other features of MetS being risk factors for CKD.…”

Urological Procedures in Urolithiasis and Their Association with Chronic Kidney Disease

“…Not only do urologic procedures manage the kidney stone event itself, our study provides evidence that they may help to prevent long-term deterioration in kidney function as seen in previous studies. 6,[12][13][14][15][16][17] Limitations There were several limitations to this study. Patients with kidney stones were identified either by seeking medical care for symptoms related to an acute episode or incidentally on imaging such as computed tomography or ultrasound.…”

“…14 On the contrary, Yoo et al 15 found, in a retrospective analysis of 131 nephrolithiasis patients with stage 3 and 4 CKD and mean observation period of 3.2 years, that stone removal by ESWL was associated with delayed deterioration of renal function in CKD patients with nephrolithiasis. Percutaneous renal surgery in the solitary kidney is safe, and it results in renal function preservation.…”

“…One long-term study showed that the risk for elevated serum creatinine levels is not increased in patients receiving conservative management, ESWL, or percutaneous nephrolithotomy. 13 Regarding outcomes of urologic procedures, no evidence was found in the literature to suggest that ESWL results in long term deterioration of renal function in patients with chronic renal insufficiency or a solitary kidney.14 On the contrary, Yoo et al 15 found, in a retrospective analysis of 131 nephrolithiasis patients with stage 3 and 4 CKD and mean observation period of 3.2 years, that stone removal by ESWL was associated with delayed deterioration of renal function in CKD patients with nephrolithiasis. Percutaneous renal surgery in the solitary kidney is safe, and it results in renal function preservation.…”