Gecit I et al, 2012: Tissue damage in kidney, adrenal glands and diaphragm following extracorporeal shock wave lithotripsy
Gecit I, Kavak S, Oguz EK, Pirincci N, Gunes M, Kara M, Ceylan K, Kaba M, Tanik S.
Department of Urology, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey.
Abstract
This study was designed to investigate whether exposure to short-term extracorporeal shock wave lithotripsy (ESWL) produces histologic changes or induces apoptosis in the kidney, adrenal glands or diaphragm muscle in rats. The effect of shock waves on the kidney of male Wistar rats (n ¼ 12) was investigated in an experimental setting using a special ESWL device. Animals were killed at 72 h after the last ESWL, and the tissues were stained with an in situ Cell Death Detection Kit, Fluorescein. Microscopic examination was performed by fluorescent microscopy. Apoptotic cell deaths in the renal tissue were not observed in the control group under fluorescent microscopy. In the ESWL group, local apoptotic changes were observed in the kidney in the area where the shock wave was focused. The apoptotic cell deaths observed in the adrenal gland of the control group were similar to those observed in the ESWL groups, and apoptosis was occasionally observed around the capsular structure. Apoptotic cell deaths in the diaphragm muscle were infrequently observed in the control group. Apoptosis in the ESWL group was limited to the mesothelial cells. This study demonstrated that serious kidney, adrenal gland and diaphragm muscles damage occurred following ESWL, which necessitated the removal of the organ in the rat model. It is recognized that the ESWL complications related to the kidney, adrenal gland and diaphragm muscles are rare and may be managed conservatively.
Toxicol Ind Health. 2012 Oct 24. [Epub ahead of print]
PMID: 23095486[PubMed - as supplied by publisher]
Comments 1
This article reports data from an animal experiment in which the occurrence of apoptosis in kidneys, adrenals and diaphragm was recorded in control animals and animals treated with 2000 shock waves. Following SWL apoptotic changes were observed in the kidney tissue in close relation to the shock wave focus, but the changes were small and of minor importance (a result that unfortunately is not correctly stated in the abstract). The tissue changes disappeared as the distance from the focus increased, but the results showed that it is necessary to avoid exposure of large volumes of renal tissue to shock wave power. Reduction of respiratory movements thus is an important part of the treatment procedure not only for maintaining a high hit rate of shock waves but also for reducing the risk of tissue damage.
Hans-Göran Tiselius