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Cecere N et al, 2015: Renovascular acute renal failure precipitated by extracorporeal shock wave lithotripsy for pancreatic stones.

Cecere N, Goffette P, Deprez P, Jadoul M, Morelle J.
Division of Nephrology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.
Division of Medical Imaging , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.
Division of Gastroenterology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.

Abstract

Extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones is considered a safe and efficient method to facilitate fragmentation and stone removal. We describe the case of a 73-year-old woman with a solitary functioning kidney who presented an acute-onset anuria and
renovascular renal failure the day after ESWL. We speculate that vascular calcifications in the area targeted by shock waves played a critical role in renal artery obstruction in the present case. 

Clin Kidney J. 2015 Aug;8(4):426-9. doi: 10.1093/ckj/sfv031. Epub 2015 May 25

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Comments 1

Hans-Göran Tiselius on Wednesday, 30 December 2015 11:05

This is indeed an extremely unusual complication observed following SWL of a pancreatic stone. As indicated in the CT-images the SW path might have been perpendicularly directed towards the severely calcified aorta and renal arteries. The lesson learnt is that extreme care is mandatory in patients with this pathology. Low number of SW and a low SW frequency seem indicated. For these patients a low energy level of the SW is usually sufficient because most pancreatic stones are composed of calcium carbonate which, in the majority of cases, is a very brittle crystal phase.

This is indeed an extremely unusual complication observed following SWL of a pancreatic stone. As indicated in the CT-images the SW path might have been perpendicularly directed towards the severely calcified aorta and renal arteries. The lesson learnt is that extreme care is mandatory in patients with this pathology. Low number of SW and a low SW frequency seem indicated. For these patients a low energy level of the SW is usually sufficient because most pancreatic stones are composed of calcium carbonate which, in the majority of cases, is a very brittle crystal phase.
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