The impact of high‐dose lithotripsy on renal structure and function

These studies characterized the effects of normal and high ‘‘doses’’ of shock waves on renal structure and function in healthy and compromised kidneys of young, anesthetized pigs. A ‘‘normal’’ dose of 2000 shock waves (24 kV, unmodified HM3 lithotripter) to one kidney produced lesions comprising about 8% of functional renal mass, transiently reduced renal blood flow and glomerular filtration rate (GFR) in both kidneys, and reduced regional perfusion in shocked kidneys. High doses of shock waves to one kidney (8000 shocks at 24 kV) produced larger lesions (about 14%), intensified the initial vasoconstriction in both kidneys, and sustained the reduction of GFR in the shocked kidneys for at least 24 h after treatment. The administration of 2000 shock waves (24 kV) to pyelonephritic (compromised) kidneys exaggerated the structural/functional impairment by inducing large lesions and intense vasoconstriction normally seen only after 8000 shock waves in healthy kidneys. We conclude that both shock wave number and preexisting renal disease increase the severity of tissue injury and functional impairment produced by shock wave lithotripsy. Since renal ischemia and inflammation occur in association with such injury, subsequent renal scarring and permanent loss of functional renal mass may also be related to shock wave dosage.