Shock Wave Lithotripsy (SWL) Induces Structural and Functional Changes in the Kidney

摘要

Early clinical studies suggested that SWL was free of bioeffects. However, recent experimental and clinical studies have clearly documented acute and chronic renal changes. The foundation for understanding the characteristics and consequences of clinical SWL-injury has been well controlled renal structural and functional studies in the pig, a model that closely mimics the human kidney. Our studies show that 2000 shocks at 24 kV administered by the Dornier HM3 induces a predictable, irreversible vascular injury at F2 that is associated with a transient renal vasocontrictive event in both treated and untreated kidneys. The SWL-induced trauma is associated with inflammation at the site of damage. While lesion size increases with kV level and shock wave number, the pronounced vasoconstriction has a lower threshold for these same parameters. Kidney size and pre-existing renal injury are also risk factors for SWL exaggerated impairment of renal tubular and hemodynamic function observed at a clinical dose. Thus, there is still a concern that SWL may generate a major health risk for some stone patients.