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Berte N, Cayzergues L, Meyer F, Jira H, Eugene M, Conti M, Loric S, Hammoudi Y, Benoit G, Droupy S, Hubert J, Eschwege P. [Ischemic lesions in kidneys after extracorporeal shock wave lithotripsy demonstrated by Proton NMR spectroscopy of urine samples]. Prog Urol 2011; 21:455-8. [PMID: 21693355 DOI: 10.1016/j.purol.2011.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 02/01/2011] [Accepted: 02/11/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this prospective study was to investigate the effect of extracorporeal shock wave lithotripsy (SWL) on kidneys of patients with pyelic stone disease. The effects of SWL were assessed by high-resolution proton nuclear magnetic resonance (HNMR) spectroscopy of urine samples. METHODS Twenty-three patients, aged 31-80years (mean: 55years), with pyelic stone disease were investigated before and after SWL. Multiparameter analysis was performed by HNMR spectroscopy of urine samples collected before and 5h after SWL (second miction post-SWL). RESULTS The most relevant resonances determined by HNMR spectroscopy were acetate, lactate, trimethylamine N-oxide and amino acids. Excretion of these markers increased significantly in comparison with pre-SWL urinary samples. CONCLUSION These results show that early ischemic damage occurs after SWL. Post-SWL. HNMR spectroscopy is an effective tool for noninvasive follow-up of renal damage.
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Affiliation(s)
- N Berte
- Service d'urologie, hôpitaux de Brabois, CHU de Nancy, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
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A chronic outcome of shock wave lithotripsy is parenchymal fibrosis. ACTA ACUST UNITED AC 2010; 38:301-5. [PMID: 20632169 DOI: 10.1007/s00240-010-0297-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
Abstract
Shock wave lithotripsy (SWL) is widely viewed as an effective noninvasive method to break stones within the kidney and ureter. However, it is a technology that is not without trauma to the kidney--acute vascular, tubular and interstitial damage is often reported that if severe enough can lead to renal fibrosis (scarring) and permanent loss of functional parenchyma. These chronic changes can potentially lead to serious long-term adverse effects. The risk of developing chronic fibrotic lesions after lithotripsy is influenced by the number of shock waves (SWs) administered, SW power, rate of SW delivery and the number of SWL treatment sessions. The interplay between these risk factors is largely unknown, but progress has been made in identifying SWL protocols and pharmacologic therapies that can ameliorate the acute and chronic tissue damage that is an unintended consequence of SWL treatment.
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Clark DL, Connors BA, Evan AP, Willis LR, Handa RK, Gao S. Localization of renal oxidative stress and inflammatory response after lithotripsy. BJU Int 2009; 103:1562-8. [PMID: 19154498 DOI: 10.1111/j.1464-410x.2008.08260.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if the acute renal oxidative stress and inflammation after extracorporeal shock wave lithotripsy (ESWL), thought to be mediated by ischaemia, is most severe in the portion of the kidney within the focal zone of the lithotripter, and if these effects result primarily from ischaemic injury. MATERIALS AND METHODS Pigs (7-8-weeks old) received either 2000 shock waves at 24 kV to the lower-pole calyx of one kidney or unilateral renal ischaemia for 1 h. A third group (sham) received no treatment. Timed urine and blood samples were taken for analysis of lipid peroxidation and the inflammatory cytokines, tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). At 4 h after treatment, kidneys were removed and samples of cortex and medulla were frozen for analysis of cytokines and heme oxygenase-1 (HO-1). RESULTS ESWL did not affect urinary excretion of malondialdehyde, but did elicit an eight-fold induction of HO-1 in the portion of the renal medulla within the focal zone of the lithotripter (F2), while remaining unchanged elsewhere in the treated kidney. There was no induction of HO-1 in renal tissue after ischaemia-reperfusion. Urinary excretion of TNF-alpha increased from the lithotripsy-treated kidney by 1 h after treatment, but was unaffected by ischaemia-reperfusion. As with the HO-1 response after lithotripsy, IL-6 increased only in the renal medulla at F2. By contrast, ischaemia-reperfusion increased IL-6 in all samples from the treated kidney. CONCLUSION These findings show that the acute oxidative stress and inflammatory responses to ESWL are localized to the renal medulla at F2. Furthermore, the differing patterns of markers of injury for ESWL and ischaemia-reperfusion suggest that ischaemia is not the principal cause of the injury response after ESWL.
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Affiliation(s)
- Daniel L Clark
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Shao Y, Connors BA, Evan AP, Willis LR, Lifshitz DA, Lingeman JE. Morphological changes induced in the pig kidney by extracorporeal shock wave lithotripsy: nephron injury. ACTA ACUST UNITED AC 2004; 275:979-89. [PMID: 14533172 DOI: 10.1002/ar.a.10115] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While shock wave lithotripsy (SWL) is known to cause significant damage to the kidney, little is known about the initial injury to cells along the nephron. In this study, one kidney in each of six juvenile pigs (6-7 weeks old) was treated with 1,000 shock waves (at 24 kV) directed at a lower pole calyx with an unmodified HM-3 lithotripter. Three pigs were utilized as sham-controls. Kidneys were fixed by vascular perfusion immediately after SWL or sham-SWL. Three of the treated kidneys were used to quantitate lesion size. Cortical and medullary samples for light (LM) and transmission electron microscopy (TEM) were taken from the focal zone for the shock waves (F2), the contralateral kidney, and the kidneys of sham-SWL pigs. Because preservation of the tissue occurred within minutes of SWL, the initial injury caused by the shock waves could be separated from secondary changes. No tissue damage was observed in contralateral sham-SWL kidneys, but treated kidneys showed signs of injury, with a lesion of 0.2% +/- 0.1% of renal volume. Intraparenchymal hemorrhage and injury to tubules was found at F2 in both the cortex and medulla of SWL-treated kidneys. Tubular injury was always associated with intraparenchymal bleeding, and the range of tissue injury included total destruction of tubules, focal cellular fragmentation, necrosis, cell vacuolization, and membrane blebbing. The initial injury caused by SWL was cellular fragmentation and necrosis. Cellular vacuolization, membrane blebbing, and disorganization of apical brush borders appear to be secondary changes related to hypoxia.
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Affiliation(s)
- Youzhi Shao
- Department of Histology, Jinzhou Medical College, Jinzhou, Liaoning Province, People's Republic of China
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IN VIVO ASSESSMENT OF FREE RADICAL ACTIVITY DURING SHOCK WAVE LITHOTRIPSY USING A MICRODIALYSIS SYSTEM:. J Urol 2002. [DOI: 10.1097/00005392-200201000-00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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MUNVER RAVI, DELVECCHIO FERNANDOC, KUO RAMSAYL, BROWN SPENCERA, ZHONG PEI, PREMINGER GLENNM. IN VIVO ASSESSMENT OF FREE RADICAL ACTIVITY DURING SHOCK WAVE LITHOTRIPSY USING A MICRODIALYSIS SYSTEM: THE RENOPROTECTIVE ACTION OF ALLOPURINOL. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65463-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- RAVI MUNVER
- From the Comprehensive Kidney Stone Center, Division of Urology, Departments of Surgery and Mechanical Engineering and Materials Science, Duke University Medical Center, Durham, North Carolina
| | - FERNANDO C. DELVECCHIO
- From the Comprehensive Kidney Stone Center, Division of Urology, Departments of Surgery and Mechanical Engineering and Materials Science, Duke University Medical Center, Durham, North Carolina
| | - RAMSAY L. KUO
- From the Comprehensive Kidney Stone Center, Division of Urology, Departments of Surgery and Mechanical Engineering and Materials Science, Duke University Medical Center, Durham, North Carolina
| | - SPENCER A. BROWN
- From the Comprehensive Kidney Stone Center, Division of Urology, Departments of Surgery and Mechanical Engineering and Materials Science, Duke University Medical Center, Durham, North Carolina
| | - PEI ZHONG
- From the Comprehensive Kidney Stone Center, Division of Urology, Departments of Surgery and Mechanical Engineering and Materials Science, Duke University Medical Center, Durham, North Carolina
| | - GLENN M. PREMINGER
- From the Comprehensive Kidney Stone Center, Division of Urology, Departments of Surgery and Mechanical Engineering and Materials Science, Duke University Medical Center, Durham, North Carolina
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Sarica K, Bakir K, Yağci F, Topçu O, Akbay C, Sayin N, Korkmaz C. Limitation of shockwave-induced enhanced crystal deposition in traumatized tissue by verapamil in rabbit model. J Endourol 1999; 13:343-7. [PMID: 10446793 DOI: 10.1089/end.1999.13.343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the possible protective effect of verapamil (a calcium channel blocking agent) against the traumatizing effects of high-energy shockwaves (HESW) and new stone formation, as indicated by crystal deposition in the renal parenchyma, an experimental study was performed in rabbits. METHODS A total of 65 rabbits were included. During severe hyperoxaluria induced by continuous ethylene glycol (EG) (0.75%) administration, animals in the first group (N = 15) received EG only, and animals in the second group underwent administration of 500 to 1500 shockwaves, animals in the third group (N = 15) received verapamil (0.1 mg/kg) for 3 days prior to HESW application, a control group (N = 15) received various numbers (500 to 1500) of shockwaves alone. Sham-treated animals (N = 5) constituted the last group in our study. Three months after shockwave application, tissue sections obtained from treated and untreated kidneys were evaluated histopathologically under light microscopy and transmission electron microscopy (TEM) for the presence and degree of crystal deposition in the cortical parenchymal region subjected to HESW. RESULTS Whereas crystal deposition was evident in the intercellular region and intratubular parts of the parenchyma in animals receiving EG and HESW, especially in those receiving relatively higher numbers of shockwaves), animals receiving verapamil demonstrated limited or no crystal formation. No significant crystal deposition could be noted in specimens from animals undergoing either EG or SWL alone, and sham-treated animals demonstrated no significant alteration, as expected. CONCLUSION Using this model, the traumatic effects of HESW could be evaluated as a factor in new stone formation after SWL. Verapamil has been found to be protective against crystal deposition.
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Affiliation(s)
- K Sarica
- Department of Urology, Sahinbey Hospital, University of Gaziantep Medical School, Turkey.
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Sarica K, Ozer G, Soygür T, Yaman O, Ozer E, Ustün H, Yaman LS, Göğüş O. Preservation of shock-wave-induced renal histologic changes by dermatan sulfate. Urology 1997; 49:145-50. [PMID: 9000207 DOI: 10.1016/s0090-4295(96)00446-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the protective effects of glycosaminoglycan (GAG) administration on shock-wave-induced renal histologic alterations, an experimental study using dermatan sulfate administration (DS) in rabbits was performed. METHODS The study included 45 white New Zealand rabbits; 36 were divided into two groups before shock-wave application. Animals in the first group (n = 18) received no specific medication before or after shock-wave treatment; animals in the second group (n = 18) received subcutaneous DS administration for a period of 2 months, beginning 2 weeks before shock-wave application. Following different numbers of shock-wave application (500, 1000, or 1500 shock waves), histopathologic evaluation of treated kidneys was made under light microscopy after 24 hours and 3 months. Nine animals were used for the control group. RESULTS During 24-hour examination, most of the kidneys in both groups demonstrated varying degrees of histopathologic alterations, depending on the number of shock waves applied. Among the most prominent pathologic features were protein deposition with free erythrocytes in the tubular lumen, glomerular hemorrhage, tubular dilation and degeneration, protein in Bowman's capsule, hyperemia, and mononuclear cell infiltration at the interstitial level. As opposed to the 24-hour evaluation findings, long-term (3-month) follow-up examination revealed histopathologic alterations that decreased but did not totally disappear in animals receiving no DS. Glomerular basement membrane thickening, mononuclear cell infiltration and limited protein deposition in some tubules, together with cortical interstitial fibrosis, were observed to some extent in these animals. On the other hand, no severe histopathologic alteration with normal glomerular basement membrane appearance was noted in animals receiving DS medication. CONCLUSIONS Our results indicated a long-term favorable protective effect of DS administration on morphologic abnormalities in rabbits undergoing shock-wave treatment. Although tubular alterations persisted to some extent, mononuclear cell infiltration has been limited and the natural appearance of the basement membrane has been well preserved in most of the treated animals.
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Affiliation(s)
- K Sarica
- Department of Urology, Ibn-i Sina Hospital, University of Ankara, Medical School, Turkey
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Baltaci S, Ozer G, Soygür T, Yaman O, Sarica K, Müftüoğlu YZ, Göğüş O. Effects of extracorporeal shockwave lithotripsy on urinary concentration of epidermal growth factor. J Endourol 1996; 10:519-21. [PMID: 8972784 DOI: 10.1089/end.1996.10.519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
In a prospective study, we tried to determine whether extracorporeal shockwave lithotripsy (SWL) has any effect on urinary epidermal growth factor (EGF) concentrations and to investigate whether EGF can be used as a marker for detecting shockwave-induced impairment of distal tubular cells. A total of 12 patients with renal pelvic or caliceal stones < or = 2 cm undergoing anesthesia-free SWL without ancillary measures and a control group of 10 patients without any urologic symptoms were included in this study. The urinary concentrations of EGF were measured by radioimmunoassay before and 4 hours, 24 hours, and 7 days after SWL. Relative urinary EGF concentrations were expressed as the ratio of EGF to creatinine (ng/mL creatinine). The mean urinary EGF concentration (mean +/- standard error) in control subjects and patients with renal pelvic or caliceal stones before SWL was 23.90 +/- 3.15 ng/mL creatinine and 22.18 +/- 6.85 ng/mL creatinine, respectively (p > 0.05). In patients with stones, we found a decrease in urinary EGF concentration 4 hours, 24 hours, and 7 days after SWL. Indeed, 7 days after SWL, the EGF concentration was on average half of the original value, a biologically significant, although not statistically significant, decrease.
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Affiliation(s)
- S Baltaci
- Department of Urology, Ankara University, Ibn-i Sina Hospital, Turkey
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Yaman O, Sarica K, Ozer G, Soygür T, Kutsal O, Yaman LS, Göŭş O. Protective effect of verapamil on renal tissue during shockwave application in rabbit model. J Endourol 1996; 10:329-33. [PMID: 8872729 DOI: 10.1089/end.1996.10.329] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Although extracorporeal shockwave lithotripsy (SWL) is the treatment of choice for symptomatic urinary calculi, it has been shown in number of studies that adverse effects of high-energy shockwaves may be encountered in short- and long-term follow-up. To evaluate the possible protective effect of verapamil administration on renal tissue, both magnetic resonance imaging (MRI) and histopathologic examination were performed after SWL in rabbits. Thirty-five animals were divided into three groups. The 15 animals in the first group were fed verapamil (0.1 mg/kg) for 3 days. Another 15 animals received no medication but underwent SWL, and the remaining 5 animals received anesthesia alone (sham group). The animals were then subdivided into three groups according to the shockwave number applied (1000, 15,000, or 2000) and the aforementioned evaluations were performed 24 hours and 3 months after the procedure. We found prominent histopathologic alterations in animals not receiving any medication before SWL. Persistence of these pathologic alterations during 3 months of follow-up indicated the importance of preservation of renal architecture during high-energy shockwave application. On the other hand, animals under verapamil medication prior to SWL demonstrated only a limited degree of histopathologic alteration. Demonstration of a normal histologic pattern after 3 months supported the preservation of tissue structure by such medication. No significant histopathologic alteration could be observed in the sham-group animals, as expected. Our study demonstrates that verapamil is protective against shockwave-induced renal tubular damage. Such medications may be useful to avoid the proven histopathologic and functional side effects of high-energy shockwaves.
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Affiliation(s)
- O Yaman
- Department of Urology, Ibn-1 Sina Hospital, University of Ankara School of Medicine, Turkey
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Strohmaier WL, Abelius A, Billes I, Grossmann T, Wilbert DM, Bichler KH. Verapamil limits shockwave-induced renal tubular damage in vivo. J Endourol 1994; 8:269-73. [PMID: 7981736 DOI: 10.1089/end.1994.8.269] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Previous investigations on Madin Darby Canine Kidney (MDCK) cells demonstrated the protective effect of verapamil against shockwave-induced tubular dysfunction. In the present study, we investigated whether verapamil is also protective against shockwave-induced damage in vivo. Male rates were randomly assigned to three groups: verapamil (N = 18) (Group I), control (N = 18) (Group II), or sham treatment (N = 4) (Group III). Groups I and II were treated with 500 shockwaves to each kidney with the Dornier MFL 5000 at 18 kV. Animals assigned to Group III received only anesthesics. Verapamil was given to the animals in Group I for 5 days starting 1 day before shockwave exposure. Urine was collected for 8 hours the day before and immediately, 1.7, and 28 days after shockwave exposure (SWE) for measurement of volume, osmolality, hemoglobin, protein, N-acetyl-beta-glucosaminidase (NAG), beta 2-microglobulin (beta 2M), sodium, and creatinine. Kidneys were perfused and removed for histologic study 1, 7, and 28 days after SWE in six animals of Groups I and II. Blood was taken in these rats (Day 1 after SWE) for the determination of creatinine and sodium and the calculation of the creatinine clearance (CCr) and the fractional excretion of sodium (FENa). After SWE, there was strong diuresis and significantly increased excretion of NAG and beta 2M in the controls, while urine osmolality decreased. These changes were significantly less pronounced in the verapamil-treated rats. The CCr was higher and FENa lower than in the latter group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W L Strohmaier
- Department of Urology, Eberhard Karls University, Tübingen, Germany
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Preminger GM. Review: in vivo effects of extracorporeal shock wave lithotripsy: animal studies. J Endourol 1993; 7:375-8. [PMID: 8298617 DOI: 10.1089/end.1993.7.375] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- G M Preminger
- Department of Surgery, Duke University Medical Center, Durham, NC
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