title: Evaluation of acute post-shock wave lithotripsy renal changes by dynamic magnetic resonance imaging: a prospective clinical study.
abstract: OBJECTIVE
  We studied acute renal morphological and hemodynamic changes after shock wave lithotripsy of renal stones.
  
  
  METHODS
  A total of 60 adult patients with a single renal stone 25 mm or less in a radiologically normal urinary tract were eligible for shock wave lithotripsy and included in analysis. Study exclusion criteria were hypertension, diabetes mellitus, previous recent stone management and other contraindications to shock wave lithotripsy. Renal perfusion and morphological changes were evaluated by dynamic magnetic resonance imaging before, and 2 to 4 hours and 1 week after lithotripsy.
  
  
  RESULTS
  In all cases there was a statistically significant decrease in renal perfusion 1 week after shock wave lithotripsy compared to before and 2 to 4 hours after lithotripsy (66% vs 71% and 72% of the aortic blood flow, respectively, p <0.05). At 1-week followup 39 unobstructed renal units (65%) showed no significant difference in renal perfusion at any time while 21 (35%) obstructed renal units showed a significant decrease in renal perfusion compared to before and 2 to 4 hours after lithotripsy (63% vs 76% and 75%, p = 0.003 and 0.005, respectively). Hematomas were observed in 7 cases (12%) 2 to 4 hours after lithotripsy, of which 5 were subcapsular and 2 were intrarenal. Three subcapsular hematomas resolved after 1 week. Localized loss of corticomedullary differentiation was observed in 2 patients (3.3%) with intrarenal hematoma 2 to 4 hours after treatment. Generalized loss of corticomedullary differentiation was observed 1 week after lithotripsy in 5 cases (8.3%).
  
  
  CONCLUSIONS
  Shock wave lithotripsy alone induces minimal, reversible acute renal morphological changes and does not induce significant changes in renal perfusion. Posttreatment obstruction has a major effect on renal perfusion on the treated side and must be managed urgently.
authors: Departments of Urology and Radiology (MAE-G), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. Electronic address: kzsheir3@hotmail.com.
authors: Khaled Z
authors: KZ
authors: Sheir
authors: Departments of Urology and Radiology (MAE-G), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Mohamed Abou
authors: MA
authors: El-Ghar
authors: Departments of Urology and Radiology (MAE-G), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Ahmed M
authors: AM
authors: Elshal
authors: Departments of Urology and Radiology (MAE-G), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Mohamed M
authors: MM
authors: Elsaadany
authors: Departments of Urology and Radiology (MAE-G), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Diaa-Eldin
authors: DE
authors: Taha
authors: Departments of Urology and Radiology (MAE-G), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Ahmed R
authors: AR
authors: El-Nahas
mesh_terms: D000328:Adult; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000473:pathology*; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
keywords: complications; kidney; lithotripsy; ureteral obstruction; urinary calculi