Handa RK et al, 2014: Shock Wave Lithotripsy Targeting of the Kidney and Pancreas does not Increase the Severity of Metabolic Syndrome in a Porcine Model
Handa RK, Evan AP, Connors BA, Johnson CD2, Liu Z, Alloosh M, Sturek M, Evans-Molina C, Mandeville JA, Gnessin E, Lingeman JE
Department of Anatomy & Cell Biology, Indiana University School of Medicine, Indianapolis, IN
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, IN
Department of Medicine and the Herman B Wells Center for Pediatric Research of Indiana University School of Medicine, Indianapolis, IN
Kidney Stone Institute of Indiana University Health Methodist Hospital, Indianapolis, IN
PURPOSE: To determine whether shock wave lithotripsy (SWL) treatment of the kidney of metabolic syndrome (MetS) pigs worsens glucose tolerance or increases the risk of developing diabetes mellitus.
MATERIALS AND METHODS: Nine-month-old female Ossabaw miniature pigs were fed a hypercaloric atherogenic diet to induce MetS. At 15 months of age, pigs were treated with 2000 SWs or 4000 SWs (24 kV at 120 SWs/min) using the unmodified Dornier HM3 lithotripter. SWs were targeted to the upper pole calyx of the left kidney so as to model treatment that would also expose the tail of the pancreas to SWs. Intravenous glucose tolerance tests (IVGTTs) were performed on conscious, fasting pigs before SWL and at 1 month and 2 months post-SWL with blood samples taken for glucose and insulin measurement.
RESULTS: Pigs fed the hypercaloric atherogenic diet were obese, dyslipidemic, insulin resistant and glucose intolerant-consistent with the development of MetS. Assessment of insulin resistance, glucose tolerance and pancreatic beta cell function from fasting plasma glucose and insulin levels, and the glucose and insulin response profile to IVGTTs, were similar before and after SWL.
CONCLUSIONS: The MetS status of SWL treated pigs was unchanged 2 months following treatment of the kidney with 2000 high-amplitude SWs or overtreatment with 4000 high-amplitude SWs. These findings do not support a single SWL treatment of the kidney as a risk factor for the onset of diabetes mellitus.
J Urol. 2014 Mar 18. pii: S0022-5347(14)02968-1. doi: 10.1016/j.juro.2014.03.035. [Epub ahead of print]
PMID:24657667[PubMed - as supplied by publisher]. FREE ARTICLE
It is reassuring that this animal study, in similarity with several recent clinical observations and despite obvious pancreatic tissue injuries, was not associated with decreased insulin response and risk of diabetes type 2 development. This is the result at least in a short term perspective and with SWL carried out with the large focus and the low energy density in a Dornier HM3 lithotripter. On the other hand the treatment was completed at a high energy level and with a large number of shockwaves administered at a high frequency.