The evaluation of impact of extacorporeal shock wave lithotripsy (ESWL)
on kidney function based on parametric renal clearance imaging
Article published in Urologia Polska 2008/61/Supl. 1.
Tomasz Konecki, Izabela Frieske, Jacek Ku¶mierek, Marek Sosnowski
- I Klinika Urologii UM w Łodzi, Uniwersytecki Szpital Kliniczny nr 2 im. WAM w Łodzi
Zakład Medycyny Nuklearnej UM w Łodzi
Introduction and objectives. Extracorporeal shock wave lithotripsy is nowadays a basic treatment method for urinary lithiasis. It gained a widespread acceptance due to being noninvasive and effective. However, experimental studies on animal models showed the presence of posstraumatic morphologic lesions in treated kidney that may affect the function of the organ. The aim of the study is to detect and evaluate the renal cortex injury and its function impairement after ESWL treatment of renal lithiasis.
Material and methods. The study prospectively evaluated 44 patients with untreated renal lithiasis, the size of the stone 10-20 mm and no hydronephrosis in ultrasonography and inravenous pyelography. The patients underwent ESWL procedure using lithotriptor Lithostar Modularis Vario with equal total energy per procedure. Before the treatment, one week, and one month afterwards, all the patients had renoscintigraphy with 99mTc-EC of 130 Mbq activity carried out together with evaluation of renal plasma clearance using multisample method. The evaluation of renal cortex injury was done based on renoscintigraphy, using parametric kidney clearance imaging. The method was elaborated in Nuclear Medicine Deparment of Medical University in Lodz. It is based on the Patlak-Rutland theory and presents the distribution of kidney clearance within the organ. The patients in whom sustained renal function abnormalities were observed underwent another renoscintigraphy three months after ESWL.
Results. The group of 20 patients, who completed all diagnostic tests, were assessed. The analysis of parametric renal clearance images revealed detorioration of regional renal function in 10 (50%) patients, compared to before treatment, which retreated in 8 (40%) patients one month and in the other two 3 months after the treatment. There was no change in the distribution of renal clearance after ESWL in 10 (50 %) patients. No statistically significant differences were seen within other parameters defined by renoscintigraphy.
Conclusions. Preliminary results show that patients undergoing ESWL treatment may experience detorioration of regional kidney function that is of subsiding character at longer followup.