Protective Effect of Verapamil on Shock Wave Induced Renal Tubular Dysfunction

Abstract

In a prospective randomized study, the effects of the calcium entry blocker verapamil on shock wave induced tubular impairment were examined. A total of 24 patients with renal pelvis or caliceal stones undergoing anesthesia-free extracorporeal shock wave lithotripsy (ESWL*) without auxiliary measures was randomly assigned to the verapamil group (12) or the control group (12). Four doses of verapamil (80 mg. each) were given orally starting the night before ESWL. Controls received no medication. To assess renal tubular function the urinary excretion of alpha 1-microglobulin, N-acetyl-beta-glucosaminidase and Tamm-Horsfall protein were determined before, immediately, and 12 and 24 hours after ESWL. After ESWL there was an increase in urinary alpha 1-microglobulin and N-acetyl-beta-glucosaminidase, which was significantly higher in the control than in the verapamil group. Tamm-Horsfall protein, a glycoprotein synthesized by the distal tubules, decreased significantly less in the verapamil group compared to the controls. Our results indicate that verapamil exhibits a protective effect on shock wave induced tubular damage. The underlying mechanisms are not elucidated yet, and direct actions on tubular cells and interference with renal hemodynamics are to be discussed.

Limitation of Shock-Wave-Induced Renal Tubular Dysfunction by Nifedipine

“…Since different treatment parameters as impulse rate and generator vol tage were not present in this study and proteinuria and enzymuria before ESWL, marking the performance status of the tubules, were not different, we conclude that 1,4-dihydropyridine nifedipine could reduce the damaging effect of high-energy shock waves on renal tubular cells. The magnitude of limitation of shock-wave-induced dam age was similar to that which we observed by the applica tion of phenylalkylamine verapamil [10,11], Obviously, this protective effect is not restricted to one subgroup of calcium entry blockers.…”

Functional MRI of the kidney: tools for translational studies of pathophysiology of renal disease

“…Due to a lack of suitable techniques, the mechanisms responsible for such redistribution are not fully understood. It has been demonstrated that vasoactive substances may have an influence on the observed responses (141). In a subsequent study (17), it was shown that aminophylline abolished the drop in cortical flow with no significant change in the medulla.…”

Protective effects of diltiazem and tadalafil on shock wave-induced kidney injury in rats

“…They considered that these medicines reduced the effects of the reactive oxygen species on tissues (24). Strohmeier et al studied the effects of verapamil (a CCB) and nifedipine on SWL-treated patients and evaluated the tubular excretion markers after SWL treatment which indicated that these CCBs had protective effects on tubular injury and dysfunction of tubular excretion (5,25).…”

“…However, it is associated with both short-and long-term risks of renal and extra renal complications (1)(2)(3). Several mechanisms, such as cavitation bubbles, temporary decrease of renal perfusion and ischemia-reperfusion (I/R) injury, are responsible for renal injury during SWL (4)(5)(6). New generation SWL devices are clinically used to decrease complication rates (1).…”