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Milišić E. et al., 2019: Short-term changes in renal function in children and adolescents undergoing extracorporeal shock wave lithotripsy

Milišić E, Zvizdić Z, Jonuzi A, Begić E, Milišić L, Mešić A.
Clinic of Paediatric Surgery, Clinical Centre University of Sarajevo, Bosnia and Herzegovina.
Department of Surgery, School of Medicine, Sarajevo School of Science and Technology, Bosnia and Herzegovina.
Department of Cardiology, General Hospital "Prim.dr. Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina.
Department of Pharmacology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina.
Clinic of Radiology, Clinical Centre of the University of Sarajevo, Bosnia and Herzegovina.
Clinic of Anaesthesiology, Clinical Centre of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina.

Abstract

Aim To identify short-term effects of extracorporeal shock wave lithotripsy (ESWL) on renal function in children and adolescents with single kidney stones. Methods In a 4-year period 30 children (15 boys and 15 girls) from 10 to 18 years of age were treated for unilateral renal stones with ESWL. Inclusion criteria were: up to 18 years of age, kidney stone (from 4 to 20 mm in diameter) visible on X-ray, first ESWL treatment, unilateral lithotripsy treatment without previous kidney surgery, patients without infravesical obstruction, patients without proven urinary infection, repeated use of one (the same) analgesic, patients without anticoagulant and antihypertensive therapy, patients without use of nephrotoxic drugs prior to and during the treatment, normal blood pressure, non-pregnancy patients with normal renal function. Serum enzymes (alkaline phosphatase, lactate dehydrogenase), cystatin C, serum and urine electrolytes (sodium, potassium, chloride), and urine neutrophil gelatinase-associated lipocalin (uNGAL) were tested before, on the first and fifth day after the treatment. Results An increase of alkaline phosphatase and lactate dehydrogenase was statistically significant on day 1 (p<0.05) and values returned to normal on day 5. Serum cystatin C level was also significantly increased during the first four days after ESWL treatment (p<0.05) and returned to baseline on post-treatment day 5. There was a statistically significant difference in the level of uNGAL in urine before and 24 hours after ESWL treatment (p<0.05). Conclusion The ESWL is a safe and curative procedure for the treatment of kidney stones in children and adolescents with no evidence of serious adverse effects on renal function.

Med Glas (Zenica). 2019 Aug 1;16(2). doi: 10.17392/1036-19. [Epub ahead of print]

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Comments 1

Hans-Göran Tiselius on Friday, January 24 2020 08:15

Despite more than 30 years of experience with SWL there is limited information on short-term and long-term negative effects on the renal tissue. This issue, however, is of particular importance when treating children and adolescents. Accordingly the authors have addressed this question in the present report.

All treatments were carried out with the electrohydraulic lithotripter Dornier HM4.

The serum variables analysed were: ALP, LDH and cystatin C. All these variables essentially increased on day 1 and returned to normal on day 5. Other changes were marginal only and considered to be of less or no clinical importance.

NGAL analysed in urine also increased but did not return to normal on day 5!

The conclusion drawn by the authors was that a larger population and longer follow-up (>5 days) will be necessary for reasonable conclusions both on long-term effects on NGAL and on renal function.

Despite more than 30 years of experience with SWL there is limited information on short-term and long-term negative effects on the renal tissue. This issue, however, is of particular importance when treating children and adolescents. Accordingly the authors have addressed this question in the present report. All treatments were carried out with the electrohydraulic lithotripter Dornier HM4. The serum variables analysed were: ALP, LDH and cystatin C. All these variables essentially increased on day 1 and returned to normal on day 5. Other changes were marginal only and considered to be of less or no clinical importance. NGAL analysed in urine also increased but did not return to normal on day 5! The conclusion drawn by the authors was that a larger population and longer follow-up (>5 days) will be necessary for reasonable conclusions both on long-term effects on NGAL and on renal function.
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