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Handa RK et al, 2015: Effect of renal shock wave lithotripsy on the development of metabolic syndrome in a juvenile swine model: a pilot study.

Handa RK, Liu Z, Connors BA, Evan AP, Lingeman JE, Basile DP, Tune JD.
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana.
Kidney Stone Institute of Indiana University Health Methodist Hospital, Indianapolis, Indiana.

Abstract

PURPOSE: A pilot study was conducted to assess whether renal shock wave lithotripsy (SWL) influences the onset and severity of metabolic syndrome (MetS).
MATERIALS AND METHODS: Three-month-old juvenile female Ossabaw miniature pigs were treated with SWL (2000 SWs, 24 kV, 120 SWs/min using the HM3 lithotripter; n=2) or sham-SWL (no SWs; n=2). SWs were targeted to the upper pole of the left kidney so as to model treatment that would also expose the pancreatic tail to SWs. Pigs were then instrumented for direct measurement of arterial blood pressure via an implanted radiotelemetry device, and later fed a hypercaloric atherogenic diet for ∼7 months. The development of MetS was assessed from intravenous glucose tolerance tests (IVGTTs).
RESULTS: The progression and severity of MetS was similar in the sham-treated and SWL-treated groups. The only exception was with respect to arterial blood pressure, which remained relatively constant in the sham-treated pigs but began to rise at ∼2 months towards hypertensive levels in SW-treated pigs. Metabolic data from both groups were pooled to provide a more complete assessment of the development and progression of MetS in this juvenile pig model. IVGTTs revealed substantial insulin resistance with impaired glucose tolerance within 2 months on the hypercaloric atherogenic diet with signs of further metabolic impairment at 7 months.
CONCLUSIONS: These preliminary results suggest that renal SWL is not a risk factor for worsening of glucose tolerance or the onset of diabetes mellitus, but does appear to be a risk factor for early onset hypertension in MetS. 

J Urol. 2015 Apr;193(4):1409-16. doi: 10.1016/j.juro.2014.09.037. Epub 2014 Sep 22.

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Comments 1

Peter Alken on Wednesday, 26 August 2015 13:05

The group from Indianapolis has made significant contributions to our understanding of the effects and side effects of ESWL. Since many years their standard model is “2000 SWs, 24 kV, 120 SWs/min using the HM3 lithotripter” preferably applied on young pigs. They and others have contributed to the evidence that this setting causes a significant and permanent renal trauma. This is what was to be expected in this small series. But what else could you prove by this setting? A proper doses of digitalis improves the heart function, a toxic doses will kill the patient.
In the same issue of the J. Urol. they report on pancreatic trauma induced by 2000 to 4000 SWs, 24 kV, 120 SWs/min using the HM3 lithotripter on the upper pole of the left kidney. There they state in the discussion: ”...we treated the kidneys of MetS pigs with SW doses that were higher than the clinical norm and at SW doses that consistently damaged the kidney ... ” (Handa RK, Evan AP, Connors BA, Johnson CD, Liu Z, Alloosh M, Sturek M, Evans-Molina C, Mandeville JA, Gnessi E, Lingeman JE.; Shock wave lithotripsy targeting of the kidney and pancreas does not increase the severity of metabolic syndrome in a porcine model. J Urol. 2014 Oct;192(4):1257-65)

In the last paragraph in the discussion of the reviewed paper it says: “Limitations of this pilot study include: the small number of pigs in each group; the early death of a control (sham-SWL) pig; and the study was not powered to detect significance between groups. Therefore, our results should be viewed as exploratory in nature.”
I do not understand why this study on 4 pigs was done, why it was submitted for publication and why it was accepted.

The group from Indianapolis has made significant contributions to our understanding of the effects and side effects of ESWL. Since many years their standard model is “2000 SWs, 24 kV, 120 SWs/min using the HM3 lithotripter” preferably applied on young pigs. They and others have contributed to the evidence that this setting causes a significant and permanent renal trauma. This is what was to be expected in this small series. But what else could you prove by this setting? A proper doses of digitalis improves the heart function, a toxic doses will kill the patient. In the same issue of the J. Urol. they report on pancreatic trauma induced by 2000 to 4000 SWs, 24 kV, 120 SWs/min using the HM3 lithotripter on the upper pole of the left kidney. There they state in the discussion: ”...we treated the kidneys of MetS pigs with SW doses that were higher than the clinical norm and at SW doses that consistently damaged the kidney ... ” (Handa RK, Evan AP, Connors BA, Johnson CD, Liu Z, Alloosh M, Sturek M, Evans-Molina C, Mandeville JA, Gnessi E, Lingeman JE.; Shock wave lithotripsy targeting of the kidney and pancreas does not increase the severity of metabolic syndrome in a porcine model. J Urol. 2014 Oct;192(4):1257-65) In the last paragraph in the discussion of the reviewed paper it says: “Limitations of this pilot study include: the small number of pigs in each group; the early death of a control (sham-SWL) pig; and the study was not powered to detect significance between groups. Therefore, our results should be viewed as exploratory in nature.” I do not understand why this study on 4 pigs was done, why it was submitted for publication and why it was accepted.
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