Effect of MPL 9000 extracorporeal shock wave lithotripsy on renal hemodynamics and urine flow: assessment by 99mTc-DTPA renal scintigraphy

The true clinical significance of renography in nephro-urology

Isotopic renography is a non-invasive technique used routinely by the clinician to provide information about kidney structure and function. Whilst there is no doubt of its value in the accurate measurement of glomerular filtration rate and in the detection of parenchymal abnormalities, its role in the diagnosis of renovascular disease (especially in patients with renal insufficiency), the exclusion of obstruction and the evaluation of the patient with either acute renal failure or renal transplant dysfunction remains unproven. In part, this reflects a failure to standardise protocols and rigorously evaluate diagnostic techniques. Recent developments in ultrasound, computerised X-ray tomography and nuclear magnetic resonance now present the clinician with rival techniques and emphasise the need for the clinical development of isotopic renography.

Examination of intrarenal blood flow by Doppler ultrasound before and after extracorporeal shock wave lithotripsy for urolithiasis

This study was aimed to test whether therapeutical extracorporeal shock wave lithotripsy (ESWL) may induce changes in renal parenchymatous blood flow, thereby indirectly indicating shock wave side effects on the renal parenchyma. In 18 patients, a Duplex ultrasound investigation of both kidneys was performed before and after ESWL. Pulsatility Index (PI), which is an estimation of renovascular resistance, increased in both treated and untreated kidney. However, the increase was confined to a subgroup of seven patients, who had received meperidine (a morphine analgetic) for analgesia. This increase is more likely to be due to a pharmacological effect of meperidine rather than a direct effect of ESWL on renal hemodynamics. In conclusion, we did not find any evidence of ESWL related affection of renal blood flow measured with duplex ultrasound, a technique sensitive enough to detect changes in renal hemodynamics due to morphine analgetics.