Prevention of Lithotripsy-Induced Renal Injury by Pretreating Kidneys with Low-Energy Shock Waves

Abstract

Lithotripsy shock waves (SW) to one renal pole damage that pole but protect the opposite pole from the damage inflicted by another, immediate application of SW. This study investigated whether the protection (1) occurs when the first treatment causes no injury, (2) is caused by SW or injury, (3) exhibits a threshold, and (4) occurs when the same pole receives both treatments. Six- to 7-wk-old anesthetized female pigs were studied. The following groups were studied: group 1 (n = 4), 2000 SW at 12 kV to one pole and 2000 SW at 24 kV (standard) to the opposite pole; group 2 (n = 6), same as group 1 except 500 12-kV SW pretreatment; group 3 (n = 8), 500 12-kV, 2000 standard SW, all to the same pole; and group 4 (n = 8), same as group 3 except 100 12-kV SW pretreatment. Mean ± SD lesion size in group 1, first pole treated, was 0.66 ± 0.82% of functional renal volume (FRV; P < 0.05 versus 5.22 ± 3.6% FRV with no pretreatment [NP]; 95% confidence interval [CI] −7.0 to −2.1) and 0.50 ± 0.68% FRV in the opposite pole after 2000 standard SW (P < 0.05 versus NP; 95% CI −9.4 to −0.08). Mean lesion size (first pole) in group 2 was 0.020 ± 0.028% FRV (P < 0.01 versus NP; 95% CI −9.2 to −1.2) and 0.43 ± 0.54% FRV in the opposite pole after 2000 standard SW (P < 0.05 versus NP; 95% CI −8.8 to −0.82). Same-pole SW (groups 3 and 4) also protected. Mean lesion sizes were 0.28 ± 0.33% (P < 0.01 versus NP; 95% CI −8.0 to −1.9) in group 3 and 0.39 ± 0.48% FRV (P < 0.01 versus NP; 95% CI −8.2 to −1.7) in group 4. It is concluded that the pretreatment protocol substantially limits the renal injury that normally is caused by SWL and occurs when the pretreatment and standard SW are applied to the same pole. The threshold for the protection may be <100 SW.