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Lee FC et al, 2015: Renal Vasoconstriction Occurs Early During Shockwave Lithotripsy in Humans.

Lee FC, Hsi RS, Sorensen MD, Dunmire B, Liu Z, Bailey MR, Harper JD.
Department of Urology, University of Washington School of Medicine , Seattle, Washington.
Division of Urology, Department of Veteran Affairs Medical Center , Seattle, Washington.
Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington , Seattle, Washington.
Department of Biostatistics, Indiana University Schools of Medicine and Public Health , Indianapolis, Indiana.

Abstract

INTRODUCTION: In animal models, pretreatment with low-energy shock waves and a pause decreased renal injury from shockwave lithotripsy (SWL). This is associated with an increase in perioperative renal resistive index (RI). A perioperative rise is not seen without the protective protocol, which suggests that renal vasoconstriction during SWL plays a role in protecting the kidney from injury. The purpose of our study was to investigate whether there is an increase in renal RI during SWL in humans.
MATERIALS AND METHODS: Subjects were prospectively recruited from two hospitals. All subjects received an initial 250 shocks at low setting, followed by a 2-minute pause. Treatment power was then increased. Measurements of the renal RI were taken before start of procedure, at 250, after 750, after 1500 shocks, and at the end of the procedure. A linear mixed-effects model was used to compare RIs at the different time points.
RESULTS: Fifteen patients were enrolled. Average treatment time was 46 ± 8 minutes. Average RI at pretreatment, after 250, after 750, after 1500 shocks, and post-treatment was 0.67 ± 0.06, 0.69 ± 0.08, 0.71 ± 0.07, 0.73 ± 0.07, and 0.74 ± 0.06, respectively. In adjusted analyses, RI was significantly increased after 750 shocks compared with pretreatment (p = 0.05).
CONCLUSION: Renal RI increases early during SWL in humans with the protective protocol. Monitoring for a rise in RI during SWL is feasible and may provide real-time feedback as to when the kidney is protected.

J Endourol. 2015 Oct 26. [Epub ahead of print]

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Comments 1

Peter Alken on Monday, 04 January 2016 08:02

Good type T1, “bench-to-bedside” translational research. If work like this is expanded and integrated into daily routine ESWL becomes more than just putting the patient on the table. Unfortunately the urological community is sometimes slow in developing, adapting and integrating new standards.

(See also: Bailey M, Lee F, Hsi R, Paun M, Dunmire B, Liu Z, Sorensen M, Harper J.
Shockwave lithotripsy with renoprotective pause is associated with renovascular vasoconstriction in humans. IEEE Int Ultrason Symp. 2014 Sep 3;2014:1013-1016 and the review by Hans-Göran Tiselius)

Good type T1, “bench-to-bedside” translational research. If work like this is expanded and integrated into daily routine ESWL becomes more than just putting the patient on the table. Unfortunately the urological community is sometimes slow in developing, adapting and integrating new standards. (See also: Bailey M, Lee F, Hsi R, Paun M, Dunmire B, Liu Z, Sorensen M, Harper J. Shockwave lithotripsy with renoprotective pause is associated with renovascular vasoconstriction in humans. IEEE Int Ultrason Symp. 2014 Sep 3;2014:1013-1016 and the review by Hans-Göran Tiselius)
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