ESWL-Induced Renal Damage — An Experimental Study

Muschter, R.; Schmeller, N.; Reimers, I; Kutscher, K. R.; Knipper, A.; Hofstetter, A.; Löhrs, U.

doi:10.1007/978-3-642-72735-1_30

Cited by 11 publications

(10 citation statements)

References 1 publication

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“…In contrast to the studies of Eisenberger et al [2] who applied only a few shock waves, the newer studies have used considerably more, thus making them comparable to the numbers of shock waves used in clinical practice. Some workers even go very much higher than this number [15], Mutscher et al [5] could not demonstrate any loss of function in treated kidneys using laboratory chemistry tests. Ruiz-Marcellan et al [6] mesured N-acetyl glucosaminidase (NAG) and lactate dehydrogenase (LDH) in the blood and urine of 44 patients immediately before and after ESWL, to sec if ESWL therapy caused the liberation of lysosomal enzymes as a consequence of renal tubular damage.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical studies have used pre-and postoperative computer or MRI investigations to detect morphological changes [4][5][6][7] or have employed laboratory tests of certain renal function parameters [8][9][10], The experimental studies have used histological examinations on animal kidneys exposed to ESWL [2,9,[11][12][13][14][15][16], The above-mentioned symptoms, which have been observed in other ESWL centers and reported many times, prompted us to consider the ques tion of the possibility of ESWL-related renal tissue damage by means of an animal experiment using canine kidneys. The object of the experiment was to try and explain the above-mentioned phenomena and to determine if they were associated with long-term renal damage.…”

Section: Introductionmentioning

confidence: 99%

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Morphological and Functional Changes in Canine Kidneys following Extracorporeal Shock-Wave Treatment

Jaeger¹,

Redha

et al. 1995

Urol Int

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Extracorporeal shock-wave lithotripsy (ESWL) has rapidly become established worldwide as a routine method for treatment of nephro- and ureterolithiasis. Although initial studies showed no tissue-damaging effect by the shock waves, we found, in an animal experiment using canine kidneys, that the ESWL-induced damage to the renal parenchyma is more marked than originally assumed. The damage is limited to the area that was focused on, and heals relatively rapidly by connective tissue encapsulation with final cicatrisation without any further residual effects being observed up to the present. This parenchymal damage is probably also the cause of the macrohematuria that is always observed during therapy. The resulting tissue damage is not extensive enough to cause a demonstrable reduction of function as measured by the usual methods (serum creatinine, creatinine clearance, isotopy renography, i.v. urography). In serum we observed a transient decrease of calcium, an immediate increase of lactate-dehydrogenase, transaminases (SGOT and SGPT) and a delayed increase of alkaline phosphates. Creatinine, blood urea nitrogen, sodium, potassium and amylase remained within normal limits. In urine, a decrease of creatinine and an increase of glucose excretion were noted. We believe that these changes represent a relatively mild and transient damage of renal cells and do not reflect the occasionally heavy morphological changes observed after shock-wave exposure. The main clinical complication is the large subcapsular hematoma which, according to the present knowledge, could well result from a lesion of the larger peripheral vessels. Damage to other organs such as subserous colonic and small bowel hematomata are to be expected although they do not lead to clinical symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Morphological and Functional Changes in Canine Kidneys following Extracorporeal Shock-Wave Treatment

Jaeger¹,

Redha

et al. 1995

Urol Int

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“…In connection with tissue damage, there are publica tions which indicate that, at pressure levels higher than about 400-500 bar, renal tissue might be damaged when the shockwave focus is concentrated on the tissue itself [18][19][20]. Consequently pressure levels above 400 bar have to be taken into account concerning renal tissue damage.…”

Section: Shockwave Pressure and Tissue Damage 'Focal Zone' Discussionmentioning

confidence: 99%

Pressure-Optimized Lithotripsy with the Siemens Lithostar: Successful and Tissue-Protecting Treatment of Urinary Stones

Folberth¹

1990

Eur Urol

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“…There have been many studies on the influence of shockwave number on renal damage (Table 5), but few on the impact of generator voltage [13,17,25,35]. Delius et al [13] demonstrated the threshold for induction of pulmonary hemorrhage by positioning canine lungs at different distances from the focus (F 2).…”

Section: Influence Of Generator Voltagementioning

confidence: 99%

“…Delius et al [13] demonstrated the threshold for induction of pulmonary hemorrhage by positioning canine lungs at different distances from the focus (F 2). Muschter et al [35] and E1-Damanhoury et al [17] showed that the trauma to a porcine kidney increased with the generator voltage when either an electrohydraulic or an electromagnetic generator voltage (kV), since the acoustic output from different shockwave sources differs significantly at the same kilovoltage. Based on our study, we strictly limited the number of impulses at the maximal energy setting of the Modulith and Lithostar Plus (Fig.…”

Section: Influence Of Generator Voltagementioning

confidence: 99%

Experimental basis of shockwave-induced renal trauma in the model of the canine kidney

et al. 1993

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Using the new electromagnetic shockwave source of the Modulith SL 20 shockwave-induced renal trauma was evaluated by acute and chronic studies in the the canine kidney model. In a further study the electromagnetic shockwave source of the Lithostar Plus Overhead module was tested. Overall, 92 kidneys were exposed to shock waves coupled either by water bath (Modulith lab type) or by water cushion (Modulith prototype, Lithostar Overhead) under ultrasound localization. The generator voltage ranged between 11 and 21 kV, the number of impulses between 25 and 2500. After application of 1500/2500 shocks the extent of the renal lesion depended strictly on the applied generator voltage and was classified into 4 grades: Grade 0, no macroscopic trauma detectable (at 11-12 kV); grade 1, petechial medullary bleeding (at 13 kV); grade 2, cortical hematoma (at 14-16 kV); and grade 3, perirenal hematoma (17-20 kV). Whereas at low and medium energy levels the number of shocks played only a minor role, at maximal generator voltage (20 kV) even 25 impulses induced a grade 2 and 600 shocks a grade 3 lesion, emphasizing the importance of shockwave limitation in the upper energy range. In shockwave-induced renal trauma a vascular lesion was predominant and cellular necrosis was secondary. Coupling with a water cushion resulted in a 15%-20% decrease in the disintegrative and traumatic effect, which was compensated for by increasing the generator voltage by 2 kV. Long-term studies showed complete restitution following grade 1 and 2 trauma, whereas after a grade 3 lesion a small segmental and capsular fibrosis without hyperplasia of the juxtaglomerular apparatus was observed. Based on the characteristic ultrasound pattern found in the first study, the threshold for induction of grade 1 lesion was investigated. With both lithotripters a wide range for induction of a grade 1 lesion (Modulith 234-411, Lithostar Plus 220-740) and also a significant overlapping with grade 0 and 2 lesions was seen at low energy settings (levels 2-4). In contrast, the range of shocks (Modulith 96-150, Lithostar Plus 90-142) and overlapping was minimal when high energy was used (levels 7-9). Finally, the disintegration-trauma coefficient combining the results obtained in a standard stone model with those of the canine kidney model was introduced.

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ESWL-Induced Renal Damage — An Experimental Study

Cited by 11 publications

References 1 publication

Morphological and Functional Changes in Canine Kidneys following Extracorporeal Shock-Wave Treatment

Morphological and Functional Changes in Canine Kidneys following Extracorporeal Shock-Wave Treatment

Pressure-Optimized Lithotripsy with the Siemens Lithostar: Successful and Tissue-Protecting Treatment of Urinary Stones

Experimental basis of shockwave-induced renal trauma in the model of the canine kidney

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