title: Shock wave lithotripsy causes ipsilateral renal injury remote from the focal point: the role of regional vasoconstriction.
abstract: OBJECTIVE
  Shock wave lithotripsy induced renal damage can occur as a result of multiple mechanisms, including small vessel injury and free radical production. Previous studies have demonstrated that shock wave lithotripsy exerts a regional change in renal hemodynamics, resulting in a global reduction in the glomerular filtration rate and renal plasma blood flow. We determined if biochemical evidence of cellular damage could be identified in ipsilateral locations remote from the shock wave site or in the contralateral kidney, suggesting regional or systemic alterations in renal function.
  
  
  METHODS
  Ten juvenile female swine underwent open insertion of microdialysis probes into the renal parenchyma at the right upper and lower poles, and left lower pole. The animals were divided evenly into a sham and a treatment group. Dialysate samples were collected from all 3 sites from the sham group at 10-minute intervals for 100 minutes and quantitatively assessed for conjugated dienes, a measure of lipid peroxidation and free-radical activity, signifying renal cellular damage. The animals in the treatment group underwent shock wave lithotripsy focused on the right lower pole. Dialysate samples were collected from all 3 sites at baseline and at 1,000 shock intervals for a total of 10,000 shocks and analyzed for conjugated dienes. The results from the sham and treatment groups as well as from the different locations within each group were compared using Student's t test.
  
  
  RESULTS
  The mean conjugated diene ratio for the sham group was 3.59, 3.42 and 2.7 microM. for the right upper and lower poles, and left kidney (p >0.05). A dose related increase in conjugated diene ratio levels from the right lower pole (lithotripsy site) and to a lesser degree from the ipsilateral right upper pole were observed, which were significantly different from sham group measurements or the contralateral kidney of the treatment group (p <0.05). The elevation in conjugated diene levels at the lithotripsy site was also noted to be significantly greater than that of the upper pole of the ipsilateral kidney (p <0.05).
  
  
  CONCLUSIONS
  The increase in free radical activity at a site remote from the treated region suggests detrimental global effects from shock wave lithotripsy therapy. These observations could be the result of vasoconstriction throughout the treated kidney with resultant ischemia-reperfusion injury. Although these global renal effects may subject patients with baseline renal dysfunction to irreversible renal damage, the clinical significance of our findings is unclear and warrants further investigation.
authors.affiliation: Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Delvecchio
authors.forename: Brian K
authors.initials: BK
authors.lastname: Auge
authors.forename: Ravi
authors.initials: R
authors.lastname: Munver
authors.forename: Spencer A
authors.initials: SA
authors.lastname: Brown
authors.forename: Ricardo
authors.initials: R
authors.lastname: Brizuela
authors.forename: Pei
authors.initials: P
authors.lastname: Zhong
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
mesh_terms: D000818:Animals; D005260:Female; D005609:Free Radicals / Q000378:metabolism*; D007668:Kidney / Q000098:blood supply / Q000293:injuries*; D015227:Lipid Peroxidation / Q000502:physiology*; D008096:Lithotripsy / Q000009:adverse effects*; D017551:Microdialysis; D015427:Reperfusion Injury / Q000503:physiopathology; D013552:Swine; D014661:Vasoconstriction / Q000502:physiology*
chemical_list: D005609:Free Radicals