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Pediatric kidney: functional outcome after extracorporeal shock wave lithotripsy
M C Goel1, N S Baserge, R V Babu
1Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Insights
Extracorporeal shock wave lithotripsy (ESWL) effectively treats pediatric kidney stones. This study found ESWL safe for children, with no lasting impact on kidney function or morphology.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Technology
Background:
- Renal calculi (kidney stones) pose a challenge in pediatric populations.
- Assessing the safety and efficacy of minimally invasive treatments is crucial for growing kidneys.
Purpose of the Study:
- To evaluate the efficacy and functional outcomes of extracorporeal shock wave lithotripsy (ESWL) for pediatric renal calculi.
- To assess morphological changes in the kidney after ESWL in children.
Main Methods:
- Prospective evaluation of 50 pediatric patients (2-12 years) undergoing ESWL.
- Glomerular filtration rate (GFR) measured pre- and post-ESWL using radionuclide renal scans.
- Ultrasound used to monitor for morphological changes, including hematomas.
Main Results:
- High fragmentation (86%) and clearance (82%) rates observed.
- Temporary perirenal and intrarenal hematomas noted, resolving spontaneously.
- No significant long-term changes in total or ipsilateral GFR at mean 31.7-month follow-up.
Conclusions:
- ESWL is an effective treatment for kidney stones in children.
- The procedure is safe for the pediatric population, with no adverse long-term effects on kidney function or morphology.
Purpose:
We studied the efficacy, functional outcome and morphological changes following extracorporeal shock wave lithotripsy (ESWL*) of renal calculi in a pediatric population.
Materials And Methods:
We prospectively evaluated 50 patients 2 to 12 years old (mean age 7.64) undergoing ESWL with the Siemens Lithostar Plus. Functional outcome was assessed by comparing total and ipsilateral glomerular filtration rates before and after ESWL. Glomerular filtration rate was measured using Gates' method on a 99mtechnetium-pentetic acid radionuclide renal scan corrected to body surface area times 1.73 m.2. Ultrasound was performed to assess morphological changes after ESWL.
Results:
The immediate fragmentation rate was 86% and the clearance rate was 82%. At the end of the study 40 patients were evaluable. Immediately after ESWL ultrasonography showed perirenal hematoma in 3 patients, intrarenal hematoma in 2 and subcapsular hematoma in 1. These changes resolved spontaneously at followup. There was no change in total or ipsilateral glomerular filtration rate at a mean followup of 31.7 months. Before and after ESWL total glomerular filtration rates were 86.58 +/- 12.43 and 86.27 +/- 12.82 ml. per minute per 1.73 m.2, respectively. Treated kidney glomerular filtration rate decreased insignificantly from 40.58 +/- 12.61 to 40.41 +/- 12.61 ml. per minute per 1.73 m.2 at 3 months. At the last followup the change in glomerular filtration rate was insignificant.
Conclusions:
ESWL is effective in the pediatric population, and it can be safely performed without long-term bio-effects on the function or morphology of the growing kidney.