The Role of Renal Nerves in the Reduction of Kidney Blood Flow Observed After Shock Wave Lithotripsy (SWL)

摘要

A reduction in renal blood flow (65% in shocked kidneys, 33% in contralateral unshocked kidneys) has been observed following delivery of a clinical dose of shock waves (SWs) (2000 SWs, 24 kV, Dornier HM3) to only one kidney. Using a porcine renal denervation model the role of renal nerves in blood vessel constriction after SWL was examined. Pigs (6 weeks old) underwent unilateral renal denervation. Nerves along the renal artery of one kidney were identified, sectioned and painted with 10% phenol. After two weeks the pigs were anesthetized and renal function was determined using inulin and PAH clearance. The lower pole of the innervated kidney was then treated with 2000 SWs. Bilateral renal plasma flow (RPF) was measured 1 hour before and 1 hour after SWL. Both kidneys were then removed for analysis of norepinephrine (NE) content. Blood flow was reduced 50% in the shocked kidney. However, the contralateral denervated kidney (NE levels 8.7% of control) exhibited 0% change in blood flow. The blunted vascular response in the contralateral denervated kidney suggest that the SWL pressure wave stimulates renal nerve activity in intact unshocked kidneys.