Shock Wave Lithotripsy Targeting of the Kidney and Pancreas Does Not Increase the Severity of Metabolic Syndrome in a Porcine Model

Abstract

Purpose To determine whether shock wave lithotripsy (SWL) treatment of the kidney of metabolic syndrome (MetS) pigs worsens glucose tolerance or increases the risk of developing diabetes mellitus. Materials and Methods Nine-month-old female Ossabaw miniature pigs were fed a hypercaloric atherogenic diet to induce MetS. At 15 months of age, pigs were treated with 2000 SWs or 4000 SWs (24 kV at 120 SWs/min) using the unmodified Dornier HM3 lithotripter. SWs were targeted to the upper pole calyx of the left kidney so as to model treatment that would also expose the tail of the pancreas to SWs. Intravenous glucose tolerance tests (IVGTTs) were performed on conscious, fasting pigs before SWL and at 1 month and 2 months post-SWL with blood samples taken for glucose and insulin measurement. Results Pigs fed the hypercaloric atherogenic diet were obese, dyslipidemic, insulin resistant and glucose intolerant—consistent with the development of MetS. Assessment of insulin resistance, glucose tolerance and pancreatic beta cell function from fasting plasma glucose and insulin levels, and the glucose and insulin response profile to IVGTTs, were similar before and after SWL. Conclusions The MetS status of SWL treated pigs was unchanged 2 months following treatment of the kidney with 2000 high-amplitude SWs or overtreatment with 4000 high-amplitude SWs. These findings do not support a single SWL treatment of the kidney as a risk factor for the onset of diabetes mellitus.

Effect of Renal Shock Wave Lithotripsy on the Development of Metabolic Syndrome in a Juvenile Swine Model: A Pilot Study

“…These preliminary results support the notion that renal SWL is not a risk factor for diabetes, and is in agreement with our most recent findings that renal SWL does not worsen insulin resistance and glucose tolerance in adult pigs with robust MetS. 21 …”

“…Pigs were prepared for IVGTTs as previously described, 21 and performed a few days before SWL or sham-SWL and then at monthly intervals after beginning the hypercaloric atherogenic (HA) diet. Fasted, conscious pigs were restrained in a low-stress body sling and blood samples taken from a jugular vein catheter immediately before and at 5, 10, 20, 30, 40, 50 and 60 min after an intravenous bolus of sterile glucose solution (dextrose, 1 g/kg).…”

“…From IVGTT we calculated: glucose and insulin AUC; AIR G = insulin 5 min − insulin 0 min ; K G = −slope of ln(glucose) 5–20 min × 100); BCF = AIR G /(glucose 5 min − glucose 0 min ); S2 = K G /((AUC insulin(0 – 20 min) /20 min) × Vd) where Vd = injected glucose dose/(glucose peak × body weight); DI = AIR G × S2. 21 …”

Shock Wave Lithotripsy Does Not Impair Renal Function in a Swine Model of Metabolic Syndrome

“…Seven to 9-monthold female Ossabaw pigs (n = 5-6 per treatment group) were fed an excess calorie, atherogenic diet of 6,000 kcal/day to induce obesity and other features of MetS. 19,21 After 6 months on the high-fat diet, the MetS pigs underwent SWL treatment using the unmodified HM3 lithotripter. Pigs were anesthetized (induction with ketamine [20 mg/kg] and xylazine [2 mg/mL]; maintenance with 1-3% isoflurane) and the urinary collecting system of the left kidney visualized using contrast medium (injected into a ureteral catheter) and X-ray fluoroscopy.…”

“…22 The pigs in the present series of experiments had robust MetS and are a subset of the animals assessed for glucose tolerance and insulin resistance in a recently published study. 21 …”