Microvascular changes in rabbit kidneys after extracorporeal shock wave treatment

Concerns about the safety of extracorporeal shock wave lithotripsy include the risk of vascular damage and the genesis of hypertension. We evaluated gross specimens and barium microangiograms of the right kidneys of 14 rabbits exposed to shock waves; the untreated left kidneys served as controls. Six rabbits were assessed immediately after shock wave treatment, whereas the other eight rabbits had the same procedure 3 months later. All six acute phase animals showed microangiographic changes indicative of shock wave trauma, including cortical, subcapsular, and medullary extravasation of barium and patchy loss of efferent vessels. No significant vascular abnormalities were seen in the control kidneys. All kidneys treated from the animals that had delayed microangiography showed macroscopic evidence of fibrotic capsular thickening and parenchymal scarring. Microscopically, there was crowding of glomeruli and areas of avascularity. In this model, shock waves damaged the cortical circulation and resulted in persistent alterations of the microvasculature that potentially could be responsible for the abnormal secretion of renin.