title: Mechanism by which shock wave lithotripsy can promote formation of human calcium phosphate stones.
abstract: Human stone calcium phosphate (CaP) content correlates with higher urine CaP supersaturation (SS) and urine pH as well as with the number of shock wave lithotripsy (SWL) treatments. SWL does damage medullary collecting ducts and vasa recta, sites for urine pH regulation. We tested the hypothesis that SWL raises urine pH and therefore Cap SS, resulting in CaP nucleation and tubular plugging. The left kidney (T) of nine farm pigs was treated with SWL, and metabolic studies were performed using bilateral ureteral catheters for up to 70 days post-SWL. Some animals were given an NH4Cl load to sort out effects on urine pH of CD injury vs. increased HCO3 (-) delivery. Histopathological studies were performed at the end of the functional studies. The mean pH of the T kidneys exceeded that of the control (C) kidneys by 0.18 units in 14 experiments on 9 pigs. Increased HCO3 (-) delivery to CD is at least partly responsible for the pH difference because NH4Cl acidosis abolished it. The T kidneys excreted more Na, K, HCO3 (-), water, Ca, Mg, and Cl than C kidneys. A single nephron site that could produce losses of all of these is the thick ascending limb. Extensive injury was noted in medullary thick ascending limbs and collecting ducts. Linear bands showing nephron loss and fibrosis were found in the cortex and extended into the medulla. Thus SWL produces tubule cell injury easily observed histopathologically that leads to functional disturbances across a wide range of electrolyte metabolism including higher than control urine pH.
authors: Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana; International Kidney Stone Institute, Methodist Hospital, Indianapolis, Indiana; and.
authors: Andrew P
authors: AP
authors: Evan
authors: Nephrology Section, University of Chicago, Chicago, Illinois.
authors: Fredric L
authors: FL
authors: Coe
authors: Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana;
authors: Bret A
authors: BA
authors: Connors
authors: Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana;
authors: Rajash K
authors: RK
authors: Handa
authors: International Kidney Stone Institute, Methodist Hospital, Indianapolis, Indiana; and.
authors: James E
authors: JE
authors: Lingeman
authors: Nephrology Section, University of Chicago, Chicago, Illinois eworcest@uchicago.edu.
authors: Elaine M
authors: EM
authors: Worcester
mesh_terms: D000643:Ammonium Chloride / Q000008:administration & dosage; D000818:Animals; D001639:Bicarbonates / Q000097:blood / Q000652:urine; D002130:Calcium Phosphates / Q000652:urine*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007684:Kidney Tubules / Q000187:drug effects / Q000293:injuries / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D008096:Lithotripsy / Q000009:adverse effects*; D008954:Models, Biological; D053040:Nephrolithiasis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000652:urine*; D065667:Renal Elimination; D034421:Sus scrofa; D013997:Time Factors; D014563:Urodynamics; D014882:Water-Electrolyte Balance
chemical_list: D001639:Bicarbonates; D002130:Calcium Phosphates; D000643:Ammonium Chloride; C020243:calcium phosphate
keywords: histopathology; pH regulation; renal function; thick ascending limb
references: Kidney Int. 2005 Feb;67(2):576-91
references: 15673305
references: Anat Rec A Discov Mol Cell Evol Biol. 2003 Nov;275(1):979-89
references: 14533172
references: J Endourol. 2008 Jan;22(1):121-6
references: 18315482
references: J Urol. 1991 Apr;145(4):715-8
references: 2005685
references: J Urol. 1989 Dec;142(6):1516-21
references: 2585627
references: Urol Res. 1995;23(5):319-26
references: 8839389
references: Nephron. 1998;78(1):1-8
references: 9453396
references: Kidney Int. 1997 Mar;51(3):894-900
references: 9067927
references: Exp Cell Res. 2012 May 15;318(9):1011-9
references: 22405998
references: J Urol. 2010 Oct;184(4):1367-71
references: 20719342
references: Am J Physiol Renal Physiol. 2011 Jun;300(6):F1267-70
references: 21490138
references: Scand J Urol Nephrol. 1999 Oct;33(5):299-305
references: 10572992
references: J Urol. 1986 Jun;135(6):1127-33
references: 3520014
references: Am J Physiol Renal Physiol. 2008 Nov;295(5):F1286-94
references: 18715937
references: J Urol. 1986 Jun;135(6):1134-7
references: 3520015
references: Nephrol Dial Transplant. 2009 Jan;24(1):130-6
references: 18662977
references: Anat Rec (Hoboken). 2014 Apr;297(4):731-48
references: 24478243
references: J Urol. 2003 Jun;169(6):2026-9
references: 12771710
references: Semin Nephrol. 2008 Mar;28(2):200-13
references: 18359401
references: Kidney Int. 2013 Oct;84(4):657-66
references: 23636174
references: J Urol. 2015 Nov;194(5):1308-12
references: 25988516
references: BJU Int. 2009 Jun;103(11):1562-8
references: 19154498
references: J Clin Invest. 2003 Mar;111(5):607-16
references: 12618515
references: BJU Int. 2009 Mar;103(5):670-8
references: 18793297
references: J Am Soc Nephrol. 1999 Aug;10(8):1753-62
references: 10446943
references: Kidney Int. 2004 Aug;66(2):777-85
references: 15253733
references: J Urol. 1988 May;139(5):1124-7
references: 3361657
references: Pediatr Nephrol. 1999 Feb;13(2):163-70
references: 10229007
references: J Nephrol. 2002 Mar-Apr;15 Suppl 5:S88-96
references: 12027225
references: J Urol. 1996 Oct;156(4):1502-6
references: 8808917
references: J Cell Physiol. 2000 Mar;182(3):311-22
references: 10653597
references: Hypertension. 2013 Jan;61(1):208-15
references: 23184381
references: Am J Physiol. 1981 Jul;241(1):R3-16
references: 7018270