title: A Prospective Randomized Study Comparing the Effect of Different Kidney Protection Treatment Protocols on Acute Renal Injury After Extracorporeal Shockwave Lithotripsy.
abstract: To perform a prospective study to evaluate the renal protective effects of ramping protocol and pause protocol for extracorporeal shockwave lithotripsy (SWL) in human subjects.
  
  
  
  Three hundred twenty patients with solitary renal stone <15 mm were randomized to receive one of four protocols: (1) 80% power from beginning until the end of treatment; (2) the first 100 shockwaves (SWs) at 40% power, and then 80% power until the end of treatment; (3) the first 100 shocks at 40% power, followed by a 3-minute pause, and then further SWs at 80% power until the end of treatment; and (4) the first 100 shocks at 80% power, followed by a 3-minute pause, and then further SWs at 80% power until the end of treatment. The primary endpoint was the incidence of renal hematoma assessed by imaging on day 2. Spot urine samples were also collected before and after treatment for acute renal injury marker measurement.
  
  
  
  The baseline information and treatment parameters of the four groups were comparable. The overall incidence of hematoma formation was 7.69% (24 patients). The number of patients developing hematoma in the four groups was 8 (10.26%), 7 (8.97%), 6 (7.59%), and 3 (3.90%), respectively, and the incidence of hematoma among the four groups was not significantly different. Only patient's body mass index and mean blood pressure during treatment were predictors for hematoma formation. There was also no significant difference in changes in the levels of all markers and complication and hospitalization rates between the four groups.
  
  
  
  Comprehensive assessment of clinical parameters, imaging results, and urinary markers showed no obvious improvement in post-SWL renal insult by either protocol.
authors.affiliation: 1 SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong , Shatin, Hong Kong .
authors.forename: Chi-Fai
authors.initials: CF
authors.lastname: Ng
authors.affiliation: 1 SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong , Shatin, Hong Kong .
authors.forename: Sylvia
authors.initials: S
authors.lastname: Luke
authors.affiliation: 1 SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong , Shatin, Hong Kong .
authors.forename: Chi-Hang
authors.initials: CH
authors.lastname: Yee
authors.affiliation: 2 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong , Shatin, Hong Kong .
authors.forename: Winnie C W
authors.initials: WC
authors.lastname: Chu
authors.affiliation: 2 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong , Shatin, Hong Kong .
authors.forename: Ka-Tak
authors.initials: KT
authors.lastname: Wong
authors.affiliation: 3 Department of Health Technology and Informatics, Hong Kong Polytechnic University , Hong Kong .
authors.forename: John W M
authors.initials: JW
authors.lastname: Yuen
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D002985:Clinical Protocols; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000293:injuries*; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000150:complications; D052878:Urolithiasis / Q000628:therapy*
keywords: extracorporeal shockwave lithotripsy; outcome; ramping; renal injury; urolithiasis