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Short-term changes in renal function after extracorporeal shock wave lithotripsy in children
K K Villányi1, J G Székely, L M Farkas
1Department of Urology, University Medical School of Pécs, Pécs, Hungary.
Insights
Extracorporeal shock wave lithotripsy (ESWL) in children caused temporary kidney tubule damage, evidenced by elevated enzymes. Adjusting ESWL settings and spacing treatments by at least 15 days may mitigate these effects.
Area of Science:
- Pediatric Nephrology
- Urology
- Biomedical Engineering
Background:
- Extracorporeal shock wave lithotripsy (ESWL) is a common treatment for kidney stones.
- The impact of ESWL on the immature kidney remains understudied.
- Evaluating short-term renal function changes in children post-ESWL is crucial.
Purpose of the Study:
- To assess the short-term effects of ESWL on renal function in pediatric patients.
- To investigate biochemical markers of kidney injury following ESWL in children.
Main Methods:
- A cohort of 65 children with 77 kidney stones treated with ESWL were monitored.
- Renal function was evaluated through serum and urine parameters, including electrolytes and specific enzymes.
- Urinary beta-2 microglobulin excretion was measured to assess tubular damage.
Main Results:
- No significant changes in overall renal function, serum parameters, or urine electrolytes were observed.
- A transient increase in urinary aspartate transaminase, alkaline phosphatase, lactate dehydrogenase, and beta-2 microglobulin indicated proximal tubular dysfunction.
- Kidney ultrasound showed no morphological changes, and enzyme levels normalized within 15 days.
Conclusions:
- ESWL induces transient functional damage to renal tubules in children.
- Optimizing ESWL parameters (kV and shock number) may reduce adverse effects.
- A minimum interval of 15 days between ESWL treatments is recommended to allow for functional regeneration.
Purpose:
To our knowledge despite numerous studies the biological effect of extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) on the function of the immature kidney has not yet been evaluated. We determined the short-term effect of ESWL on renal function in children.
Materials And Methods:
In a 5-year period 65 children were treated for 77 kidney stones by ESWL and followed regularly at our department. In 16 children the short-term effect of shock wave energy was studied by measuring blood parameters (sodium, potassium, urea, creatinine and C-reactive protein), urinary electrolytes (sodium, potassium and creatinine), urinary enzyme activity (aspartate transaminase, alanine transferase, alkaline phosphatase and lactate dehydrogenase) and the excretion of beta 2-microglobulin. Samples were obtained immediately before and 2 hours after ESWL, and on days 1, 2, 8, 15, 30 and 90 after treatment.
Results:
Morphological changes in the kidneys were not detected by ultrasound during followup. No significant changes were noted in overall renal function, serum parameters or urine electrolytes. A significant elevation in the excretion of aspartate transaminase, alkaline phosphatase, lactate dehydrogenase and beta 2-microglobulin was observed, indicating proximal tubular dysfunction and cell destruction. Enzyme levels returned to baseline within 15 days.
Conclusions:
Our results demonstrate that shock wave energy induces transient functional damage of tubular function in children. Minimizing the kV. and number of shocks may decrease the deleterious effect. When considering functional regeneration time, the minimal interval between 2 shock wave treatments should be at least 15 days. The long-term effect needs further investigation.