Yoo DE, Han SH, Oh HJ, Kim SJ, Shin DH, Lee MJ, Yoo TH, Kang SW, Choi KH
Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
Purpose: This study aimed to elucidate whether stone removal by extracorporeal shock wave lithotripsy (ESWL) is associated with delayed chronic kidney disease (CKD) progression.
Materials and Methods: We conducted a retrospective analysis of 131 nephrolithiasis patients with stage 3 and 4 CKD. We collected baseline clinical and laboratory data, kidney stone characteristics, and history of receiving ESWL. We classified study patients into two groups according to whether they underwent ESWL or not (Non-ESWL group vs. ESWL group). We initially compared annual estimated glomerular filtration rate (eGFR) changes of Non-ESWL group with those of ESWL group before undergoing ESWL. In the next step, we sought to compare annual eGFR changes in the same patients before and after ESWL. Finally, we compared annual eGFR changes between success and failure groups among patients undergoing ESWL.
Results: The mean age of the patients was 62 years and 72.5% were male. The mean observation period was 3.2 years. Non-ESWL group and ESWL group before undergoing ESWL showed similar annual eGFR changes (-1.75±6.5 vs. -1.63±7.2 mL/min/1.73 m²/year, p=0.425). However, eGFR declined slower after undergoing ESWL than before ESWL (annual eGFR changes, -0.29±6.1 vs. -1.63±7.2 mL/min/1.73 m²/year, p<0.05). In addition, among patients in ESWL group, eGFR declined faster in the failure group than in the success group (annual eGFR change, -1.01±4.7 vs. -0.05±5.2 mL/min/1.73 m²/year, p<0.05). Conclusion: Our results suggest that stone removal by ESWL is associated with delayed deterioration of renal function in CKD patients with nephrolithiasis.
Yonsei Med J. 2012 Jul 1;53(4):708-14. doi: 10.3349/ymj.2012.53.4.708
PMID: 22665335 [PubMed - in process]
In this selected group of patients with chronic kidney disease (CKD) it was shown that the deterioration of GFR was retarded following stone removal with ESWL. There is unfortunately no information on where in the kidney the relatively large stones (mean diameter >20 mm) were located and how this stone burden might have influenced the urine flow. But the decision not to remove such large stones can be questioned, even in patients with reduced renal function.
It is difficult to deduce from the article if a particularly gentle ESWL-procedure was carried out, but obviously the ESWL procedure itself had no major negative impact on the renal function in these patients. That is something that always is feared when exposing CKD-kidneys to shockwave power.