Shock Wave Lithotripsy for Renal Stones Is Not Associated with Hypertension and Diabetes Mellitus

Sato, Yoshikazu; Tanda, Hitoshi; Kato, Shingo; Ohnishi, Shigeki; Nakajima, Hisao; Nanbu, Akihito; Nitta, Toshikazu; Koroku, Mikio; Akagashi, Keigo; Hanzawa, Tatsuo

doi:10.1016/j.urology.2007.10.072

Cited by 52 publications

(34 citation statements)

References 13 publications

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“…More recently, the same group of investigators failed to demonstrate an association between SWL and the onset of T2D in a population-based cohort of 423 adult patients during a mean follow up of ~9 years. 27 Others have also reported no change in the incidence of T2D in adult patients whose kidney stones were treated with SWs using the HM3 or Medstone STS lithotripter, with follow ups that were of a 6 year, 12 17 year 11 or 20 year duration. 28 A group of 70 pediatric patients (mean age of 6.5 years old) with renal stones were treated with single or multiple SWL sessions using the Doli S or MFL 5000 lithotripters, and had normal blood sugar values over a mean follow up period of ~5 years—that is, no patient developed T2D after SWL.…”

Section: Discussionmentioning

confidence: 99%

“…10 Shortly after the publication of the Mayo Clinic report, there were 2 additional retrospective follow up studies of 17 years or less of stone patients treated with SWL that did not show a higher incidence of T2D. 11,12 With this background of clinical information at hand, we embarked on an animal study to address the issue of whether SWL treatment could increase the risk of developing T2D. We used the Ossabaw miniature swine model that develops similar features of human metabolic syndrome (MetS) 13,14 —a cluster of factors that includes obesity, insulin resistance, impaired glucose tolerance, dyslipidemia and hypertension—and examined whether SWL of the kidney exacerbates the severity of MetS, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Shock Wave Lithotripsy Targeting of the Kidney and Pancreas Does Not Increase the Severity of Metabolic Syndrome in a Porcine Model

et al. 2014

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Purpose To determine whether shock wave lithotripsy (SWL) treatment of the kidney of metabolic syndrome (MetS) pigs worsens glucose tolerance or increases the risk of developing diabetes mellitus. Materials and Methods Nine-month-old female Ossabaw miniature pigs were fed a hypercaloric atherogenic diet to induce MetS. At 15 months of age, pigs were treated with 2000 SWs or 4000 SWs (24 kV at 120 SWs/min) using the unmodified Dornier HM3 lithotripter. SWs were targeted to the upper pole calyx of the left kidney so as to model treatment that would also expose the tail of the pancreas to SWs. Intravenous glucose tolerance tests (IVGTTs) were performed on conscious, fasting pigs before SWL and at 1 month and 2 months post-SWL with blood samples taken for glucose and insulin measurement. Results Pigs fed the hypercaloric atherogenic diet were obese, dyslipidemic, insulin resistant and glucose intolerant—consistent with the development of MetS. Assessment of insulin resistance, glucose tolerance and pancreatic beta cell function from fasting plasma glucose and insulin levels, and the glucose and insulin response profile to IVGTTs, were similar before and after SWL. Conclusions The MetS status of SWL treated pigs was unchanged 2 months following treatment of the kidney with 2000 high-amplitude SWs or overtreatment with 4000 high-amplitude SWs. These findings do not support a single SWL treatment of the kidney as a risk factor for the onset of diabetes mellitus.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Shock Wave Lithotripsy Targeting of the Kidney and Pancreas Does Not Increase the Severity of Metabolic Syndrome in a Porcine Model

et al. 2014

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“…However, no association was evident between SWL and the development of diabetes before (HR: 0.98, 95% CI: 0.76-1.26) or after (HR: 0.92, 95% CI: 0.71-1.18) SWL, controlling for age, sex, and obesity. 63 Furthermore, Sato et al 64 showed that SWL is not associated with hypertension or diabetes. Therefore, SWL is safe procedure and it is plausible to monitor patients for diabetes and hypertension.…”

Section: How Obesity-induced Renal Stone Disease Can Be a Challenge Fmentioning

confidence: 99%

Renal Stone Disease and Obesity: What is Important for Urologists and Nephrologists?

Ahmed

2012

Renal Failure

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Currently, obesity has reached an epidemic stage and represents a challenge for health authorities across the globe. Certainly, with emergence of obesity epidemic, we started to see an increase in the prevalence of chronic kidney disease (CKD) and nephrolithiasis. Interestingly, epidemiologic studies have shown that the incident stone risk increases with body mass index (BMI), and no further increase in risk is noticed when the BMI > 30 kg/m 2 . Furthermore, metabolic syndrome and diabetes are also associated with an increase in the incidence of renal stones disease. The shared links between these metabolic disorders are insulin resistance. Furthermore, insulin resistance is thought to alter renal acidbase metabolism, resulting in a lower urine pH and increased risk of uric acid stone disease. Obesity is also associated with excess nutritional intake of lithogenic substances such as refined sugars, low fluid intake, calcium, oxalate, and purine-rich foods. Obesity is also associated with an increase in incidence of urinary tract infection. Recent reports suggested that renal stone disease carries risk of myocardial infarction, progression of CKD, and diabetes. Alarmingly, orlistat (obesity medication) and bariatric surgery are associated with hyperoxaluria and associated stone formation and even oxalate nephropathy. Certainly, the many health risks of obesity, including nephrolithiasis, will add more burden on urologists and nephrologists. Shockwave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy are all safe procedures in obese individuals. Further research is urgently needed to address the pathophysiology and management of obesity-induced renal stones disease.

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“…9 They argued that SWL-induced damage to the kidney and adjacent pancreas might be responsible for the development of these complications. Due to limitations of their study and subsequent clinical reports failing to uncover such associations, 10,12,13 the urological community has been highly critical of the view that renal SWL can give rise to diabetes in adults, including those patients with predisposing risk factors such as obesity.…”

Section: Introductionmentioning

confidence: 99%

Effect of Renal Shock Wave Lithotripsy on the Development of Metabolic Syndrome in a Juvenile Swine Model: A Pilot Study

et al. 2015

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Purpose A pilot study was conducted to assess whether renal shock wave lithotripsy (SWL) influences the onset and severity of metabolic syndrome (MetS). Materials and Methods Three-month-old juvenile female Ossabaw miniature pigs were treated with SWL (2000 SWs, 24 kV, 120 SWs/min using the HM3 lithotripter; n=2) or sham-SWL (no SWs; n=2). SWs were targeted to the upper pole of the left kidney so as to model treatment that would also expose the pancreatic tail to SWs. Pigs were then instrumented for direct measurement of arterial blood pressure via an implanted radiotelemetry device, and later fed a hypercaloric atherogenic diet for ~7 months. The development of MetS was assessed from intravenous glucose tolerance tests (IVGTTs). Results The progression and severity of MetS was similar in the sham-treated and SWL-treated groups. The only exception was with respect to arterial blood pressure, which remained relatively constant in the sham-treated pigs but began to rise at ~2 months towards hypertensive levels in SW-treated pigs. Metabolic data from both groups were pooled to provide a more complete assessment of the development and progression of MetS in this juvenile pig model. IVGTTs revealed substantial insulin resistance with impaired glucose tolerance within 2 months on the hypercaloric atherogenic diet with signs of further metabolic impairment at 7 months. Conclusions These preliminary results suggest that renal SWL is not a risk factor for worsening of glucose tolerance or the onset of diabetes mellitus, but does appear to be a risk factor for early onset hypertension in MetS.

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Shock Wave Lithotripsy for Renal Stones Is Not Associated with Hypertension and Diabetes Mellitus

Cited by 52 publications

References 13 publications

Shock Wave Lithotripsy Targeting of the Kidney and Pancreas Does Not Increase the Severity of Metabolic Syndrome in a Porcine Model

Shock Wave Lithotripsy Targeting of the Kidney and Pancreas Does Not Increase the Severity of Metabolic Syndrome in a Porcine Model

Renal Stone Disease and Obesity: What is Important for Urologists and Nephrologists?

Effect of Renal Shock Wave Lithotripsy on the Development of Metabolic Syndrome in a Juvenile Swine Model: A Pilot Study

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