Abstract

Abstract

Extracorporeal shockwave lithotripsy (ESWL) has dramatically changed the treatment of urinary lithiasis and has been the first treatment option for the majority of patients for more than two decades. Despite its significant benefits, it induces acute renal injury that extends from the papilla to the outer cortex. We evaluated the severity of the inflammatory response to ESWL by measuring the urinary excretion of the cytokines TNF-α, IL-1α, and IL-6. The study included 21 selected patients and 14 control subjects. All patients underwent the same ESWL procedure (2,500 shockwaves at 100 shockwaves/min and 0.039 J from the lithotripter). Urine TNF-α, IL-1α, and IL-6 levels were measured using standard ELISA kits. In the study population (patients and controls), we did not detect TNF-α in the urine samples. The levels of both IL-1α (2.5 pg/ml) and IL-6 (3.8 pg/ml) measured before ESWL were not significantly different from the control group (2.5 and 5.2 pg/ml, respectively; p > 0.05). Twenty-four hours after ESWL, in contrast to IL-1α (4 pg/ml), urine IL-6 (19.7 pg/ml) increased significantly (p < 0.05). Fourteen days after ESWL, IL-1α increased to 5 pg/ml, while IL-6 (7 pg/ml) decreased to the control level. Urine cytokine levels may be used to evaluate the inflammatory response to ESWL. After ESWL, IL-6 levels increased in the early phase, while IL-1α levels increased later. These two markers may be used to measure the severity of inflammation. In contrast to IL-1α and IL-6, urine TNF-α excretion was not increased by ESWL. We believe that the inflammatory response to ESWL can be detected by the urinary excretion of IL-1α for up to 14 days.

Urol Res. 2012 Oct;40(5):569-73

PMID: 22314271 [PubMed - as supplied by publisher]

Comment

Comment

It is well recognized that ESWL is accompanied by an inflammatory reaction in the renal tissue. In this study increased excretion of IL-1a and IL-6 was demonstrated. The important message was that increased excretion of IL-6 was found but decreased during the following 2 weeks. IL-1a was slowly increasing at 2 weeks but the increment was less pronounced. Measurements were only carried out after 24h and after 14 days and not between these points. The clinical importance of these findings is difficult to judge, but slow resolution of the inflammatory process gives support to treatment intervals of around 2 weeks for stones located in the kidney.

Hans-Göran Tiselius