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

Abstract

Purpose: To determine whether shock wave lithotripsy (SWL) may be a risk factor for renal functional impairment in a swine model of metabolic syndrome (MetS). Materials and Methods: Nine-month-old female Ossabaw pigs were fed an excess calorie atherogenic diet to induce MetS. At 15 months of age, the MetS pigs were treated with 2000 SWs or an overtreatment dose of 4000 SWs targeted at the upper pole calyx of the left kidney (24 kV at 120 SWs/min using the unmodified Dornier HM3 lithotripter; n = 5-6 per treatment group). Serum creatinine (Cr) and blood urea nitrogen (BUN) levels were measured in conscious pigs before and *60 days after SWL to provide a qualitative assessment of how well both kidneys were filtering (glomerular filtration rate [GFR]). Bilateral renal function was assessed at *65 days post-SWL in anesthetized pigs with GFR and effective renal plasma flow (ERPF) quantified by the renal clearance of inulin and para-amino hippurate, respectively. Results: Cr and BUN values were within normal limits before SWL and remained unchanged after lithotripsy in both the 2000 SW-and 4000 SW-treated pigs. GFR and ERPF of kidneys treated with SWL at either SW dose were similar to the contralateral nontreated kidney. Chronic histological changes in the SW-treated pole of the kidney included interstitial fibrosis, sclerotic glomeruli, and dilated and atrophic tubules. Conclusions: Our results are consistent with the view that a single SWL session does not result in renal impairment, even in the presence of MetS.

Intraluminal measurement of papillary duct urine pH, in vivo: a pilot study in the swine kidney

“…The two pigs in the present series of experiments are a subset of the animals assessed for glucose tolerance and insulin resistance before and after SWL in a recently published study [12]. Details of renal function and renal pathology of such SWL-treated MetS pigs has also been published [13]. …”

Retrograde Intrarenal Surgery or Shock Wave Lithotripsy?: Comparison of the Effects on Renal Functions by Glomerular Filtration Rate

“…SWL is a less invasive treatment modality compared to RIRS, however, RIRS seems to have higher success and lower re-treatment rates (18). All these interventions affect the renal function and there are fewer studies evaluating and comparing these aspects (10,19,20).…”

“…However, a few reports evaluating long-term outcomes of SWL treatment in patients with chronic renal failure also suggest that SWL is a safe treatment modality (21,22). In their animal model of metabolic syndrome, Handa et al (20) reported that a single session of SWL did not result in renal impairment, even in the presence of metabolic syndrome. As a result of the first study in the literature investigating the effect of RIRS on renal functions, univariate cox regression analysis revealed that multiple procedures and pre-existing chronic kidney disease were significant factors for renal deterioration (19).…”

Development of a novel magnetic resonance imaging acquisition and analysis workflow for the quantification of shock wave lithotripsy-induced renal hemorrhagic injury

“…The primary acute lesion is trauma to blood vessels with extra-vasculature pooling of blood within the renal tissue. Tissue damage from SWL also extends to the tubules and glomeruli [2,3], and the production and release of inflammatory and oxidative stress mediators [4,5], which can result in fibrosis and loss of functional tissue [2,6,7]. Such injury from SWL has been linked to adverse patient outcomes, e.g.…”