The relationship between the energy levels of shock waves and the degree of renal damage after ESWL: A prospective clinical matching trail

Abstract

In an attempt to understand the effects of high energy shock wave (HESW) on renal function, we studied prospectively 40 patients with nephrolithiasis in 4 groups, using same voltage with different numbers of shock wave therapy to identify the difference of effects on renal function. Stone burdens and posit ion were similar in these groups. Each group received 1500, 2000, 2500 or 3000 pulses at 12.5 KV on JT-3 lithotripotor respectively. All the groups had significantly increased the levels of urinary NAG, β₂MG, ALB and serum β₂MG, which reached the highest values on 1–3 days after ESWL (P<0. 001), and then decreased to the pre-ESWL levels except urinary NAG in group Cand D and serum β₂MG which were still significantly higher (P< 0. 05) than those before-ESWL on the 7th day after ESWL. There was significant correlation between either urinary NAG (γ=0. 977,P<0. 05) or β₂MG (γ=0. 933,P< 0. 001) with the number of shock wave. In addition, urinary NAG and β₂MG increased significantly when the number of shock waves was over 2500 shots.

These above findings suggest that shock wave had induced acute changes in renal functions and transient renal tubular damages, although these functional changes recovered within one week, and the tubular damage might last longer than 7 days, In order to avoid serious renal damage, it’s necessary to limit the energy level of shock waves under 12. 5 KV×2500 shots by using JT-3 lithotriptor.

Keywords

extracorporeal shock wave lithotripsy / renal damage / energy level

References

[1] ChaussyC, et al.. First clinical experiences with extracorporeally induced destruction of kidney stones by shock waves. J Urol, 1982, 127: 417-417

[2] LingemanJ E, WoodsJ, TothP D, et al.. The role of lithotripsy and its side effects. J Urol, 1989, 141: 799-799

[3] MaruhnD. Rapid calorimetric assay of beta galactosidase and N-acetyl-beta-glucosaminidase in human urine. Clin Chem Acta, 1976, 73: 453-453

[4] Ruiz-MarcellanF G, Ibarz-ServioL, et al.. E-valuation of renal damage in extracorporeal lithotripsy by shock waves. Eur Urol, 1986, 12: 73-73

[5] KarlinG S, SchulsingerD. Urivetsky M, et al.. Absence of persisting parenchymal damage after ESWL as judged by excretion of renal enzyme. J Urol, 1990, 144: 13-13

[6] AssimosD G, BoyceW H, FurrE G, et al.. Selective elevation of urinary enzyme levels after ESWL.. J Urol, 1989, 142: 687-687

[7] TrinchieriA, MandressiA, ZanettiG, et al.. Renal tubular damage after renal stone treatment. Urol Res, 1988, 6: 101-101

[8] SakamotoW, KishimotoT, NakataniT, et al.. Examination of aggravat «ing factors of urinary excretion of NAG after ESWL.. Nephron, 1991, 58: 205-205

[9] PortmanR J. Use of β₂MG to diagnose tubulointerstitial renal lesions in children. Kidney Int, 1991, 30(1): 10-10

[10] WilbertD M. Glomerular and tubular damage after ESWL assessed by measurement of urinary protein. J Urol, 1988, 139: 326A-326A

[11] ESWL 1991, 6 (2): 42

[12] β₂MG 1991; 7 (1): 32

[13] KarlsenS J, BergK J. Acute changes in renal function following ESWL in patients with a solitary functioning kidney. J Urol, 1991, 145: 253-253

[14] HauptG, HauptA, DonovanJ M, et al.. Shortterm changes of laboratory values after ESWL: a comparative study. J Urol, 1989, 142: 259-259

[15] TrinchieriA, ZanettiG, TomboliniP, et al.. Urinary excretion of NAG after ESWL: a marker of renal tubule injury. Arch Ital Urol Neforl Androl, 1989, 6(4): 407-407