Carestia E. et al., 2025: Significant Changes in Low-Abundance Protein Content Detected by Proteomic Analysis of Urine from Patients with Renal Stones After Extracorporeal Shock Wave Lithotripsy.

Elena Carestia, Fabrizio Di Giuseppe, Mohammad Kazemi, Massoumeh Ramahi, Uditanshu Priyadarshi, Patricia Giuliani, Piergustavo De Francesco, Luigi Schips, Carmine Di Ilio, Renata Ciccarelli, Patrizia Di Iorio, Stefania Angelucci 
Biology (Basel). 2025 Apr 27;14(5):482. doi: 10.3390/biology14050482

Abstract

Extracorporeal shock wave lithotripsy (ESWL), although a highly effective method for the treatment of kidney stones, can cause significant kidney damage. Since urinary protein composition directly reflects kidney function, proteomic analysis of this fluid may be useful to identify changes in protein levels induced by patient exposure to ESWL as a sign of kidney damage. To this end, we collected urine samples from 80 patients with nephrolithiasis 2 h before and 24 h after exposure to ESWL, which were concentrated and subsequently processed with a commercially available enrichment method to extract low-abundance urinary proteins. These were then separated by 2D electrophoresis and subsequently analyzed by a proteomic approach. A large number of proteins were identified as being related to inflammatory, fibrotic, and antioxidant processes and changes in the levels of some of them were confirmed by Western blot analysis. Therefore, although further experimental confirmation is needed, our results demonstrate that ESWL significantly influences the low urinary protein profile of patients with nephrolithiasis. Notably, among the identified proteins, matrix metalloproteinase 7, alpha1-antitrypsin, and clusterin, as well as dimethyl arginine dimethyl amino hydrolase 2 and ab-hydrolase, may play an important role as putative biomarkers in the monitoring and management of ESWL-induced renal damage.

Comment Peter Alken

I don’t know the exact number of ESWL treatments done world-wide. Christian Chaussy (personal communication) assumes it is appr. 100 million.
What would be the frequency of a “significant kidney damage”? 1, 0,1 or 0,01%? That would be 1 million, 100.000 or 10.0000 cases and that should have served as good food for a lot of publications which I have not seen.
There is one Urologist among the 12 authors. I wonder that he agreed to the last sentence of the conclusion: “… urine proteins that could serve as potential biomarkers to predict the
severity or otherwise of the damage caused by lithotripsy and accelerate the application of
the most appropriate clinical investigations and treatments.”
I am not aware of publications on the need to accelerate clinical investigations and treatments of damage caused by lithotripsy - except the well published, rare cases of hematoma - since the introductions of ESWL 45 years ago.
I think that you can call the present and all the other studies on renal trauma due to ESWL basic research however with a focus on a wrong subject, on a chimera. Shockwaves can serve as an experimental model to simulate minor renal trauma but not to study any clinically relevant side effects of ESWL.

Peter Alken