Effect of shock wave exposure during ESWL on renal function

许多研究报道了体外冲击波碎石术(ESWL)中冲击波暴露对人体的影响。在体外实验和肾结石患者体内实验中，我们研究了高能冲击波对肾脏的影响。体外结果：高能冲击波(17KV，1mU/秒)暴露使肾脏血流量降低，用微球法计算，并在99mTC-DTPA肾图上分析初始时间-活动曲线。当射程超过500次后，肾血流量显著降低，并且这种降低与射程增加到2000次有关。DTPA肾图排泄期达到最大活性所需时间(Tmax)和达到最大活性(T_1/2)减半所需时间显著延长。所有这些变化在ESWL后观察4周，并随着ESWL重复次数的增加而加重。组织学研究显示…结果：测定了肾结石患者体外冲击波碎石(ESWL)治疗前后尿细胞逃逸酶活性和尿β2-微球蛋白、α2-微球蛋白等低分子蛋白的变化。并用99mTC-DRPA肾图研究ESWL后患者肾功能的变化。ESWL后对照侧和暴露侧肾血流量均减少。ESWL后即刻出现血尿，NAG、LDH、γ-GTP活性升高，但在4d内消失。ESWL后4天以上尿低分子蛋白水平异常升高，提示肾小管功能障碍。这些改变在合并斯氏杆菌引起的尿路感染和梗阻的患者中尤为明显。每隔1~2个月重复一次ESWL可造成约10%的患者不可逆性肾损害，且损害程度与冲击次数和总冲击次数有关。结论：冲击波暴露于肾脏可引起挫伤、出血、缺血、坏死等组织损伤，损害程度与冲击波能量和冲击次数有关。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。冲击波暴露于肾脏的疗程应至少间隔4周，以将这些因素的风险降至最低。较少

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