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Alterations in predicted growth rates of pediatric kidneys treated with extracorporeal shockwave lithotripsy
D A Lifshitz1, J E Lingeman, F S Zafar
1Department of Urology, Rabin Medical Center, Petach Tikva, Israel.
Insights
Extracorporeal shockwave lithotripsy (SWL) may negatively impact pediatric kidney growth, with treated kidneys showing reduced growth compared to expected length. Further research is needed to confirm SWL
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Physics
Background:
- Long-term effects of extracorporeal shockwave lithotripsy (SWL) on pediatric renal growth are not well-established.
- Assessing renal growth and function post-SWL is crucial for understanding potential developmental impacts.
- Pediatric renal calculi treatment requires careful consideration of long-term outcomes.
Purpose of the Study:
- To evaluate the long-term effects of SWL on renal growth rates in children treated for kidney stones.
- To analyze changes in renal length, serum creatinine, and blood pressure following SWL.
- To determine if SWL treatment is associated with impaired renal growth in pediatric patients.
Main Methods:
- Retrospective review of long-term follow-up data (mean 9 years) for 29 pediatric patients treated with an unmodified Dornier HM3 lithotripter.
- Analysis of renal length changes, serum creatinine levels, and blood pressure.
- Calculation of predicted renal growth using age-adjusted formulas and stratification of kidneys into normal and abnormal groups.
Main Results:
- No significant difference in renal size between treated and untreated kidneys at treatment or follow-up.
- Treated kidneys showed a significant negative deviation from expected length at follow-up (1.26 SD units below, p=0.02).
- Both normal and abnormal kidney groups exhibited a trend toward age-adjusted reduction in renal growth post-SWL.
Conclusions:
- SWL treatment in pediatric patients may be associated with altered renal growth patterns.
- The observed growth alterations could be due to SWL or underlying pediatric kidney pathology.
- Caution is advised when using SWL in children, employing the lowest effective dosage for stone comminution.
Abstract:
The long-term effects of extracorporeal shockwave lithotripsy (SWL) on the kidneys of children treated for renal calculi are unclear. In order to determine if SWL has any negative effects on renal growth rates, we reviewed long-term (mean 9-year) follow-up data on 29 pediatric patients treated between 1984 and 1988 with an unmodified Dornier HM3 lithotripter. Changes in renal length, serum creatinine, and blood pressure were analyzed. Predicted renal growth was calculated using a formula for age-adjusted renal length. Treated kidneys were stratified into normal and abnormal groups based on a history of renal surgery, evidence of recurrent infection, and obvious anatomic abnormalities. Fifty-six upper urinary tract calculi were treated in 34 renal units. Twenty-two renal units (68%) were rendered stone free, and 65% of the patients continue to be stone free. At follow-up, one patient was classified as having new-onset hypertension, and the mean serum creatinine was 0.93 +/- 0.08 mg/dL. Both at treatment and at follow-up, no significant differences were found in the sizes of the treated and untreated kidneys. However, at treatment, the abnormal group of kidneys seemed to be smaller than expected (mean Z -1.30 +/- 1.10), whereas the group of normal kidneys was very close (mean Z 0.18 +/- 0.54) to the predicted length. At follow-up, the deviations between actual and predicted renal length were significantly more negative. Treated kidneys were an additional 1.26 +/- 0.49 SD units below their expected length (p = 0.02). Untreated kidneys were further below normal as well but possibly to a lesser degree (-0.82 +/- 0.36; p <0.04). Although there was a trend for the abnormal group to have smaller kidneys than the normal group, both groups showed the same trend toward an age-adjusted reduction in renal growth at follow-up. The alterations in renal growth patterns observed in this population are unsettling and could be secondary to either treatment effect (SWL) or, more likely, to some underlying pathology intrinsic to pediatric kidneys with urolithiasis. Until further data are available, SWL in the pediatric population should be applied with caution and at the lowest dosage sufficient to achieve stone comminution.