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Effect of shock wave exposure during ESWL on renal function

ESWL 期间冲击波暴露对肾功能的影响

基本信息

批准号：
01570902
负责人：
KISHIMOTO Taketoshi
金额：
$ 1.02万
依托单位：
Osaka City University
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (C)
财政年份：
1989
资助国家：
日本
起止时间：
1989 至 1991
项目状态：
已结题

项目摘要

Many studies have reported the effect of shock wave exposure on the human body during extracorporeal shock wave lithotripsy (ESWL). We studied the effect of high-energy shock waves on the kidney in ex vivo experiments using dogs and in in vivo experiments on patients with kidney stones.ex vivo results : The exposure of high-energy shock waves (17kV, 1mu/sec) decreased renal blood flow rate, which was calculated using the microsphere method and analyzing the initial time-activity curve on 99mTc-DTPA renogram. The renal blood flow rate significantly decreased after more than 500 shots, and the decrease correlated with the increase in the number of shots until 2, 000 shots. Time required to reach the maximum activity (Tmax) and tixne required to reach a half of the maximum activity (T_<1/2>) of excretory phase of DTPA renogram were prolonged significantly. All these changes were observed for 4 weeks after ESWL and were aggravated by repeated sessions of ESWL. Histological studies revealed … More hemorrhage in the parenchyma of the exposed site, especially in the peritubular interstitial tissue, resulting in degeneration of tubular epithelial cell of the exposed site.in vivo results : We measured urine cell-escaped enzyme activities and urine low molecular proteins, such as beta_2-microglobulin and alpha_2-microglobulin, before and after ESWL in patients with kidney stones. We also studied changes in renal function after ESWL in these patients by 99mTc-DrPA renogram. Blood flow of the non-exposed kidney as well as the exposed kidney decreased after ESWL. Hematuria and increased activities of NAG, LDH and gammaGTP were noted immediately after ESWL, but these abnormalities subsided within 4 days. Urine low molecular proteins showed abnormally high levels for more than 4 days after ESWL, suggesting renal tubular dysfunction. These changes were especially significant in patients complicated with urinary infection and obstruction due to steinstrabetae. Repeated sessions of ESWL at intervals of one or two months caused irreversible renal damage in about 10% of the patients, and the degree of the damage correlated with the number of sessions and total shots of shock waves.Conclusion : Shock wave exposure onto the kidney apparently caused tissue damage such as contusion, hemorrhage, ischemia and necrosis, and the degree of the damage correlated with the energy of shock waves and the number of shots. Urinary infection and urinary obstruction are considered risk factors, infection being the most important factor. Sessions of shock wave exposure onto the kidney should be at least 4 weeks apart, minimizing the risks of these factors. Less

许多研究报告了体外冲击波碎石术（ESWL）中冲击波暴露对人体的影响。本文通过离体实验和体内实验研究了高能冲击波（17 kV，1 mu/sec）对肾结石患者肾脏的影响。离体实验结果：高能冲击波（17 kV，1 mu/sec）照射后，肾血流量降低，用微球法计算，并分析99 mTc-DTPA肾图的时间-活度曲线。超过500次注射后，肾血流量显著下降，并且下降与注射次数的增加相关，直到2000次注射。DTPA肾图排泄相达最大活动时间（Tmax）和达最大活动一半时间（T_（1/2））明显延长。所有这些变化在ESWL后4周内观察到，并随着ESWL的重复进行而加重。组织学研究显示 ...更多信息暴露部位实质出血，尤其是肾小管周围间质出血，导致暴露部位肾小管上皮细胞变性site.in体内结果：我们检测了肾结石患者ESWL前后尿细胞逃逸酶活性和尿低分子蛋白，如β_2-微球蛋白和α_2-微球蛋白。并应用99 mTc-DrPA肾图检查ESWL后肾功能的变化。ESWL后非暴露肾和暴露肾的血流量减少。ESWL后立即出现血尿及NAG、LDH和γ GTP活性升高，但这些异常在4天内消退。ESWL后4天以上尿低分子蛋白异常升高，提示肾小管功能障碍。这些变化在合并尿路感染和梗阻的患者中尤为明显。每隔1 ~ 2个月重复ESWL治疗约10%的患者会造成不可逆的肾损害，损害程度与ESWL治疗次数和冲击波总次数有关。冲击波暴露在肾脏上显然会引起组织损伤，如挫伤、出血、缺血和坏死，损伤程度与冲击波能量和射击次数有关。尿路感染和尿路梗阻被认为是危险因素，感染是最重要的因素。冲击波暴露在肾脏上的时间间隔应至少4周，以尽量减少这些因素的风险。少