Handa RK et al, 2015: Shock Wave Lithotripsy Does Not Impair Renal Function in a Swine Model of Metabolic Syndrome.

Friday, 27 March 2015

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Handa RK, Johnson CD, Connors BA, Evan AP, Phillips CL, Liu Z
Department of Anatomy & Cell Biology, Indiana University School of Medicine , Indianapolis, Indiana

Abstract

PURPOSE: To determine whether shock wave lithotripsy (SWL) may be a risk factor for renal functional impairment in a swine model of metabolic syndrome (MetS).
MATERIALS AND METHODS: Nine-month-old female Ossabaw pigs were fed an excess calorie atherogenic diet to induce MetS. At 15 months of age, the MetS pigs were treated with 2000 SWs or an overtreatment dose of 4000 SWs targeted at the upper pole calyx of the left kidney (24 kV at 120 SWs/min using the unmodified Dornier HM3 lithotripter; n=5-6 per treatment group). Serum creatinine (Cr) and
blood urea nitrogen (BUN) levels were measured in conscious pigs before and ∼60 days after SWL to provide a qualitative
assessment of how well both kidneys were filtering (glomerular filtration rate [GFR]). Bilateral renal function was assessed at ∼65
days post-SWL in anesthetized pigs with GFR and effective renal plasma flow (ERPF) quantified by the renal clearance of inulin
and para-amino hippurate, respectively.
RESULTS: Cr and BUN values were within normal limits before SWL and remained unchanged
after lithotripsy in both the 2000 SW- and 4000 SW-treated pigs. GFR and ERPF of kidneys treated with SWL at either SW dose were similar to the contralateral nontreated kidney. Chronic histological changes in the SW-treated pole of the kidney included interstitial fibrosis, sclerotic glomeruli, and dilated and atrophic tubules.
CONCLUSIONS: Our results are consistent with the view that a single SWL session does not result in renal impairment, even in the presence of MetS.

J Endourol. 2014 Nov 18. [Epub ahead of print]

Comments 1

Peter Alken on Friday, 27 March 2015 12:11

They keep on using their juvenile pig SWL injury model - 2000 SWs, 24 kV, 120 SWs/min - and I keep on criticizing their setting because it is like proving that an overdoses of sleeping pills is dangerous – what is well known. I do not think that there is a good reason to continue experiments in this setting just because the results can be compared with those of previous studies.

In a 5 year old publication from the Indianapolis group “Treatment protocols to reduce renal injury during shock wave Lithotripsy” by James A. McAteer, Andrew P. Evan, James C. Williams Jr, and James E. Lingeman in Curr Opin Urol. 2009 March ; 19(2): 192–195 they have summarized their experimental experience by showing that there are several ways shock wave application leads to renal trauma when using a Dornier HM3 lithotripter.
The percentage of traumatized functional renal volume (%FRV) varied
1. with the kV:
With 2000 SWs, the lesion size increased from ~ 0.3% at 12 kV to ~ 2.25% at 18 kV and to ~ 6% at 24 kV
2. with the number of SWs:
with 24 kV and 120 SWs/min the lesion size increased from:
~ 0.3% at 1000 SWs to ~ 6% at 2000 SWs and to ~ 14% at 8000 SWs
3. with the frequency of SW application:
with 120 SWs/min the lesion size increased to 3,93 % from 0,42% with 60 SWs/min
and
4. with pausing (or ramping):
With 100 SWs at 24 kV followed 3 min later by 2000 SWs the lesion size was 0.51 % versus 3.93 % with 2000 SWs only.

The last sentence of the conclusion in the present publication “Therefore, our animal data would support the view that a single session of SWL does not increase the intermediate term risk of renal functional impairment in stone formers with MetS who have normal renal function.”
should read: Therefore, the animal data would support the view that a single session of SWL which does not respect most rules that have been set to reduce the risk of renal trauma does not increase the intermediate term risk of renal functional impairment in stone formers with MetS who have normal renal function

I also refer to my comment to the groups recent publication by Handa RK, Liu Z, Connors BA, Evan AP, Lingeman JE, Basile DP, Tune JD. Effect of renal shock wave lithotripsy on the development of metabolic syndrome in a juvenile swine model: a pilot study. J Urol. 2014 Sep 19

In a 5 year old publication from the Indianapolis group “Treatment protocols to reduce renal injury during shock wave Lithotripsy” by James A. McAteer, Andrew P. Evan, James C. Williams Jr, and James E. Lingeman in Curr Opin Urol. 2009 March ; 19(2): 192–195  they have summarized their experimental experience by showing that  there are several ways shock wave application leads to renal trauma when using a Dornier HM3 lithotripter. 
The percentage of traumatized functional renal volume (%FRV) varied 
1.	with the kV:
With 2000 SWs, the lesion size increased from ~ 0.3% at 12 kV to ~ 2.25% at 18 kV and to ~ 6% at 24 kV
2.	with the number of SWs:
with 24 kV and  120 SWs/min the lesion size increased from: 
~ 0.3% at 1000 SWs to ~ 6% at 2000 SWs and to ~ 14% at 8000 SWs 
3.	with the frequency of SW application: 
with 120 SWs/min the lesion size increased to 3,93 %  from 0,42% with  60 SWs/min
and
4.	with pausing (or ramping):
With 100 SWs at 24 kV followed 3 min later by 2000 SWs the lesion size was 0.51 % versus 3.93 %  with 2000 SWs only.

The last sentence of the conclusion in the present publication “Therefore, our animal data would support the view that a single session of SWL does not increase the intermediate term risk of renal functional impairment in stone formers with MetS who have normal renal function.”
should read:  Therefore, the animal data would support the view that a single session of SWL which does not respect most rules that have been set to reduce the risk of renal trauma  does not increase the intermediate term risk of renal functional impairment in stone formers with MetS who have normal renal function

I also refer to my comment to the groups recent publication by  Handa RK, Liu Z, Connors BA, Evan AP, Lingeman JE, Basile DP, Tune JD. Effect of renal shock wave lithotripsy on the development of metabolic syndrome in a juvenile swine model: a pilot study. J Urol. 2014 Sep 19

They keep on using their juvenile pig SWL injury model - 2000 SWs, 24 kV, 120 SWs/min - and I keep on criticizing their setting because it is like proving that an overdoses of sleeping pills is dangerous – what is well known. I do not think that there is a good reason to continue experiments in this setting just because the results can be compared with those of previous studies. In a 5 year old publication from the Indianapolis group “Treatment protocols to reduce renal injury during shock wave Lithotripsy” by James A. McAteer, Andrew P. Evan, James C. Williams Jr, and James E. Lingeman in Curr Opin Urol. 2009 March ; 19(2): 192–195 they have summarized their experimental experience by showing that there are several ways shock wave application leads to renal trauma when using a Dornier HM3 lithotripter. The percentage of traumatized functional renal volume (%FRV) varied 1. with the kV: With 2000 SWs, the lesion size increased from ~ 0.3% at 12 kV to ~ 2.25% at 18 kV and to ~ 6% at 24 kV 2. with the number of SWs: with 24 kV and 120 SWs/min the lesion size increased from: ~ 0.3% at 1000 SWs to ~ 6% at 2000 SWs and to ~ 14% at 8000 SWs 3. with the frequency of SW application: with 120 SWs/min the lesion size increased to 3,93 % from 0,42% with 60 SWs/min and 4. with pausing (or ramping): With 100 SWs at 24 kV followed 3 min later by 2000 SWs the lesion size was 0.51 % versus 3.93 % with 2000 SWs only. The last sentence of the conclusion in the present publication “Therefore, our animal data would support the view that a single session of SWL does not increase the intermediate term risk of renal functional impairment in stone formers with MetS who have normal renal function.” should read: Therefore, the animal data would support the view that a single session of SWL which does not respect most rules that have been set to reduce the risk of renal trauma does not increase the intermediate term risk of renal functional impairment in stone formers with MetS who have normal renal function I also refer to my comment to the groups recent publication by Handa RK, Liu Z, Connors BA, Evan AP, Lingeman JE, Basile DP, Tune JD. Effect of renal shock wave lithotripsy on the development of metabolic syndrome in a juvenile swine model: a pilot study. J Urol. 2014 Sep 19

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