Morphological changes following ESWL in the rat kidney.
Fifty four Wistar rats were treated with 500, 1,000 or 2,000 shock waves, using the modified DORNIER HM 3 system with the new SG40 shock wave generator. The animals were sacrificed after a period of 24 hours, 7 days or 35 days. Histological examination, scanning electron microscopy (SEM) and magnetic resonance imaging (MRI) were used to evaluate acute and long term effects after extracorporeal shock-wave lithotripsy (ESWL). Acute morphological changes such as glomerular bleeding, tubular dilatation, atrophy and partial necrosis occurred immediately after ESWL throughout the kidney. SEM revealed a tubular loss of microvilli and cilia. There was restitutio ad integrum of these diffuse lesions. The extent of the long term lesions was determined by the following mechanism: venous rupture occurred during ESWL, especially in thin arcuatae veins which are, tortuous their and run between two different tissue densities. This resulted in interstitial haematoma, demonstrable by MRI; in the long term groups, the haematomas progressed to interstitial fibrosis with segmental retraction of renal convexity. The blood supply in these areas was reduced and secondary changes such as glomerular-tubular atrophy and sclerosis followed. The degree to which long-term renal lesions resulted was determined by the extent of these changes, which were shock-wave dose dependent up to a dose of 2,000 shock waves.
Department of Urology, RWTH, Aachen, Federal Republic of Germany.
F
F
Recker
H
H
Rübben
A
A
Bex
C
C
Constantinides
D000818:Animals; D001284:Atrophy; D002923:Cilia / Q000473:pathology; D004108:Dilatation, Pathologic; D005260:Female; D006406:Hematoma / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D007668:Kidney / Q000098:blood supply / Q000473:pathology*; D007674:Kidney Diseases / Q000209:etiology* / Q000473:pathology; D007678:Kidney Glomerulus / Q000098:blood supply; D008096:Lithotripsy / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008855:Microscopy, Electron, Scanning; D008871:Microvilli / Q000473:pathology; D009336:Necrosis; D051381:Rats; D011919:Rats, Inbred Strains; D014545:Urinary Calculi / Q000628:therapy*