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Uğuz S, Demirer Z, Uysal B, Alp BF, Malkoc E, Guragac A, Turker T, Ateş F, Karademir K, Ozcan A, Yildirim I, Korkmaz A, Guven A. Medical ozone therapy reduces shock wave therapy-induced renal injury. Ren Fail 2016; 38:974-81. [PMID: 27099130 DOI: 10.3109/0886022x.2016.1172941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury. METHODS Twenty-four male Sprague-Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis. RESULTS Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p < 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p < 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p < 0.05, ESW + OT vs. ESW). CONCLUSION OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.
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Affiliation(s)
- Sami Uğuz
- a Department of Urology, Gulhane Military Medical Faculty , Etlik , Ankara , Turkey
| | - Zafer Demirer
- a Department of Urology, Gulhane Military Medical Faculty , Etlik , Ankara , Turkey
| | - Bulent Uysal
- b Department of Physiology, Gulhane Military Medical Faculty , Etlik , Ankara , Turkey
| | - Bilal Firat Alp
- a Department of Urology, Gulhane Military Medical Faculty , Etlik , Ankara , Turkey
| | - Ercan Malkoc
- c Department of Urology, Gulhane Military Medical Faculty, Haydarpasa , Istanbul , Turkey
| | - Ali Guragac
- a Department of Urology, Gulhane Military Medical Faculty , Etlik , Ankara , Turkey
| | - Turker Turker
- d Department of Epidemiology, Gulhane Military Medical Faculty , Etlik , Ankara , Turkey
| | - Ferhat Ateş
- c Department of Urology, Gulhane Military Medical Faculty, Haydarpasa , Istanbul , Turkey
| | - Kenan Karademir
- c Department of Urology, Gulhane Military Medical Faculty, Haydarpasa , Istanbul , Turkey
| | - Ayhan Ozcan
- e Department of Pathology, Gulhane Military Medical Faculty , Etlik , Ankara , Turkey
| | - Ibrahim Yildirim
- a Department of Urology, Gulhane Military Medical Faculty , Etlik , Ankara , Turkey
| | - Ahmet Korkmaz
- b Department of Physiology, Gulhane Military Medical Faculty , Etlik , Ankara , Turkey
| | - Ahmet Guven
- f Department of Pediatric Surgery, Gulhane Military Medical Faculty , Etlik , Ankara , Turkey
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Aydin HR, Irkilata L, Aydin M, Daggulli M, Taskin MH, Demirel HC, Adanur S, Moral C, Atilla MK, Sancaktutar AA. The Application of Kidney Injury Molecule-1 to Determine the Duration Between Shockwave Lithotripsy Sessions. J Endourol 2015; 30:109-13. [PMID: 26407192 DOI: 10.1089/end.2015.0379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We aimed to evaluate the role of kidney injury molecule-1 (KIM-1) in determining the intervals between shockwave lithotripsy (SWL) sessions. PATIENTS AND METHODS This was a prospective, controlled study. It included 40 patients with unilateral kidney stones and 40 healthy persons of a similar age group as controls. The patients' midflow urine samples were collected before SWL and 1 hour, 1 day, 1 week, and 1 month after the procedure. RESULTS The average age in the SWL and control groups was 45 ± 14 and 39 ± 15 years, respectively (P = 0.336). The average KIM-1 value before SWL was 0.74 ± 0.35 ng/mL, which was significantly higher than that of the control group (0.51 ± 0.14 ng/mL) (P < 0.001). Similarly, the average values of the urine samples after SWL were higher than those of the control group (P < 0.001). When the KIM-1 values of the patients given SWL were compared within the group, the KIM-1 values 1 hour (1.06 ± 0.51) and 1 day (0.99 ± 0.67) after the procedure were statistically clearly higher than those before the procedure (P < 0.001) and statistically clearly higher than those of the control group (P = 0.005). The KIM-1 values 1 week and 1 month after the procedure were not significantly different than the preprocedure values (P = 0.652 and P = 0.747, respectively). CONCLUSION KIM-1 is a noninvasive biomarker that may be used to show renal damage because of stones and early-stage renal damage linked to SWL. In addition, post-SWL KIM-1 values may be used to determine the interval between SWL sessions.
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Affiliation(s)
- Hasan R Aydin
- 1 Department of Urology, Recep Tayyip Erdoğan University , Rize, Turkey
| | - Lokman Irkilata
- 2 Department of Urology, Samsun Training and Research Hospital , Samsun, Turkey
| | - Mustafa Aydin
- 2 Department of Urology, Samsun Training and Research Hospital , Samsun, Turkey
| | - Mansur Daggulli
- 3 Department of Urology, Dicle University , Diyarbakir, Turkey
| | - Mehmet H Taskin
- 4 Department of Microbiology, Samsun Training and Research Hospital , Samsun, Turkey
| | - Huseyin C Demirel
- 2 Department of Urology, Samsun Training and Research Hospital , Samsun, Turkey
| | - Senol Adanur
- 5 Department of Urology, Ataturk University , Erzurum, Turkey
| | - Caner Moral
- 2 Department of Urology, Samsun Training and Research Hospital , Samsun, Turkey
| | - Mustafa K Atilla
- 2 Department of Urology, Samsun Training and Research Hospital , Samsun, Turkey
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Malkoc E, Alp BF, Demirer Z, Guragac A, Dursun F, Ates F, Yildirim I, Yuksel R, Uysal B, Topal T, Kurt YG, Ozcan A, Guven A. Efficacy of poly(adenosine diphosphate-ribose) polymerase inhibition in extracorporeal shock wave-induced renal injury. Ren Fail 2014; 36:1564-9. [PMID: 25238491 DOI: 10.3109/0886022x.2014.962423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Extracorporeal shock wave lithotripsy (ESW) induces renal damage by excessive production of free oxygen radicals. Free Oxygen radicals cause cellular injury by inducing nicks in DNA. The enzyme poly(adenosine diphosphate-ribose) polymerase (PARP) involved in the process of repair of DNA in damaged cells. However, its activation in damaged cells can lead to adenosine triphosphate depletion and death. Thus, we designed a study to evaluate the efficacy of 3-aminobenzamide (3-AB), a PARP inhibitor, against extracorporeal shock wave induced renal injury. METHODS Twenty-four Sprague-Dawley rats were divided into three groups: control, ESW, ESW + 3-AB groups. All groups except control group were subjected to ESW procedure. ESW + 3-AB group received 20 mg/kg/day 3-aminobenzamide intraperitoneally at 2 h before ESW and continued once a day for consecutive 3 days. The surviving animals were sacrificed at the 4th day and their kidneys were harvested for biochemical and histopathologic analysis. Blood samples from animals were also obtained. RESULTS Serum ALT and AST levels, serum neopterin and tissue oxidative stress parameters were increased in the ESW group and almost came to control values in the treatment group (p < 0.05, ESW vs. ESW + 3-AB). Histopathological injury score were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + 3-AB). CONCLUSION Our data showed that PARP inhibition protected renal tissue against ESW induced renal injury. These findings suggest that it would be possible to improve the outcome of ESW induced renal injury by using PARP inhibitors as a preventive therapy.
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Affiliation(s)
- Ercan Malkoc
- Department of Urology, Gulhane Military Medical Academy Haydarpasa Training Hospital , Uskudar, Istanbul , Turkey
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Alp BF, Malkoc E, Demirer Z, Guragac A, Turker T, Altayli E, Ozcan A, Uysal B, Topal T, Akgul EO, Yildirim I, Guven A. Inhibition of inducible nitric oxide synthase prevents shock wave therapy induced renal injury. Ren Fail 2014; 36:774-80. [DOI: 10.3109/0886022x.2014.884396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yilmaz E, Mert C, Keskil Z, Tuglu D, Batislam E. Effect of SWL on renal hemodynamics: could a change in renal artery contraction–relaxation responses be the cause? ACTA ACUST UNITED AC 2012; 40:775-80. [DOI: 10.1007/s00240-012-0504-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 08/22/2012] [Indexed: 10/27/2022]
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Ellah MA, Kremser C, Pallwein L, Aigner F, Schocke M, Peschel R, Pedross F, Pinggera G, Wolf C, Alsharkawy MA, Jaschke W, Frauscher F. Changes of renal blood flow after ESWL: Assessment by ASL MR imaging, contrast enhanced MR imaging, and renal resistive index. Eur J Radiol 2010; 76:124-8. [DOI: 10.1016/j.ejrad.2009.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 05/11/2009] [Indexed: 11/21/2022]
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Handa RK, Evan AP. A chronic outcome of shock wave lithotripsy is parenchymal fibrosis. ACTA ACUST UNITED AC 2010; 38:301-5. [PMID: 20632169 DOI: 10.1007/s00240-010-0297-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
Abstract
Shock wave lithotripsy (SWL) is widely viewed as an effective noninvasive method to break stones within the kidney and ureter. However, it is a technology that is not without trauma to the kidney--acute vascular, tubular and interstitial damage is often reported that if severe enough can lead to renal fibrosis (scarring) and permanent loss of functional parenchyma. These chronic changes can potentially lead to serious long-term adverse effects. The risk of developing chronic fibrotic lesions after lithotripsy is influenced by the number of shock waves (SWs) administered, SW power, rate of SW delivery and the number of SWL treatment sessions. The interplay between these risk factors is largely unknown, but progress has been made in identifying SWL protocols and pharmacologic therapies that can ameliorate the acute and chronic tissue damage that is an unintended consequence of SWL treatment.
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Handa RK, Bailey MR, Paun M, Gao S, Connors BA, Willis LR, Evan AP. Pretreatment with low-energy shock waves induces renal vasoconstriction during standard shock wave lithotripsy (SWL): a treatment protocol known to reduce SWL-induced renal injury. BJU Int 2008; 103:1270-4. [PMID: 19154458 DOI: 10.1111/j.1464-410x.2008.08277.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To test the hypothesis that the pretreatment of the kidney with low-energy shock waves (SWs) will induce renal vasoconstriction sooner than a standard clinical dose of high-energy SWs, thus providing a potential mechanism by which the pretreatment SW lithotripsy (SWL) protocol reduces tissue injury. MATERIALS AND METHODS Female farm pigs (6-weeks-old) were anaesthetized with isoflurane and the lower pole of the right kidney treated with SWs using a conventional electrohydraulic lithotripter (HM3, Dornier GmbH, Germany). Pulsed Doppler ultrasonography was used to measure renal resistive index (RI) in blood vessels as a measure of resistance/impedance to blood flow. RI was recorded from one intralobar artery located in the targeted pole of the kidney, and measurements taken from pigs given sham SW treatment (Group 1; no SWs, four pigs), a standard clinical dose of high-energy SWs (Group 2; 2000 SWs, 24 kV, 120 SWs/min, seven pigs), low-energy SW pretreatment followed by high-energy SWL (Group 3; 500 SWs, 12 kV, 120 SWs/min + 2000 SWs, 24 kV, 120 SWs/min, eight pigs) and low-energy SW pretreatment alone (Group 4; 500 SWs, 12 kV, 120 SWs/min, six pigs). RESULTS Baseline RI (approximately 0.61) was similar for all groups. Pigs receiving sham SW treatment (Group 1) had no significant change in RI. A standard clinical dose of high-energy SWs (Group 2) did not significantly alter RI during treatment, but did increase RI at 45 min after SWL. Low-energy SWs did not alter RI in Group 3 pigs, but subsequent treatment with a standard clinical dose of high-energy SWs resulted in a significantly earlier (at 1000 SWs) and greater (two-fold) rise in RI than that in Group 2 pigs. This rise in RI during the low/high-energy SWL protocol was not due to a delayed vasoconstrictor response of pretreatment, as low-energy SW treatment alone (Group 4) did not increase RI until 65 min after SWL. CONCLUSIONS The pretreatment protocol induces renal vasoconstriction during the period of SW application whereas the standard protocol shows vasoconstriction occurring after SWL. Thus, the earlier and greater rise in RI during the pretreatment protocol may be causally associated with a reduction in tissue injury.
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Affiliation(s)
- Rajash K Handa
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Mitterberger M, Pinggera GM, Neururer R, Peschel R, Aigner F, Gradl J, Bartsch G, Kendler D, Karakolcu F, Frauscher F, Pallwein L. Multimodal evaluation of renal perfusional changes due to extracorporeal shock wave lithotripsy. BJU Int 2007; 101:731-5. [PMID: 17941931 DOI: 10.1111/j.1464-410x.2007.07281.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To examine the effect of extracorporeal shock wave lithotripsy (ESWL) on renal perfusion before and after treatment, by assessing renal resistive index (RI) using colour Doppler ultrasonography (CDUS), magnetic resonance perfusion imaging (MRPI), radionuclide renography and big-endothelin-1 values (Big-ET-1). PATIENTS AND METHODS In 69 normotensive patients the RI was measured before, 1, 3, 6 and 24 h after ESWL using CDUS. The RI values, measured in interlobar/arcuate arteries, were correlated with the findings on MRPI, done before and within 24 h after ESWL. In addition, renal plasma flow (RPF, assessed on radionuclide renography) and Big-ET-1 levels (a potent vasoconstrictor peptide), served as a control for evaluating renal perfusion. The patients were stratified in three age groups, i.e. <or=39, 40-59 and >or=60 years, with 23 patients in each group. RESULTS The mean (sd) RI increased significantly in the treated kidneys, from 0.64 (0.05) before to 0.72 (0.08) after ESWL (P = 0.001). Only in patients aged >or=60 years did the RI continue to increase over the 24 h. MRPI showed a decrease of renal blood flow (RBF) in all age groups, but most significantly in those aged >or=60 years. The radionuclide renography and big-ET-1 levels changed significantly only in the oldest group. The best correlation was between RI and RBF changes detected by MRPI. CONCLUSIONS ESWL obviously causes disturbances of renal perfusion, particularly in elderly patients (>or=60 years). Measurement of RI with Doppler techniques might provide useful information for the clinical diagnosis of renal damage.
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Abstract
Magnetic resonance imaging (MRI) provides exquisite anatomic detail of various organs and is capable of providing additional functional information. This combination allows for comprehensive diagnostic evaluation of pathologies such as ischemic renal disease. Noninvasive MRI techniques could facilitate translation of many studies performed in controlled animal models using technologies that are invasive to humans. Such a translation is being recognized as essential because many proposed interventions and drugs that prove efficacious in animal models fail to do so in humans. In this article, we review the state-of-the-art functional MRI technique as applied to the kidneys.
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Affiliation(s)
- Pottumarthi V Prasad
- Dept. of Radiology, Walgreen Jr. Bldg., Suite 507, Evanston Northwestern Healthcare, 2650 Ridge Ave., Evanston, IL 60201, USA.
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Willis LR, Evan AP, Connors BA, Handa RK, Blomgren PM, Lingeman JE. Prevention of lithotripsy-induced renal injury by pretreating kidneys with low-energy shock waves. J Am Soc Nephrol 2006; 17:663-73. [PMID: 16452495 DOI: 10.1681/asn.2005060634] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Lithotripsy shock waves (SW) to one renal pole damage that pole but protect the opposite pole from the damage inflicted by another, immediate application of SW. This study investigated whether the protection (1) occurs when the first treatment causes no injury, (2) is caused by SW or injury, (3) exhibits a threshold, and (4) occurs when the same pole receives both treatments. Six- to 7-wk-old anesthetized female pigs were studied. The following groups were studied: group 1 (n=4), 2000 SW at 12 kV to one pole and 2000 SW at 24 kV (standard) to the opposite pole; group 2 (n=6), same as group 1 except 500 12-kV SW pretreatment; group 3 (n=8), 500 12-kV, 2000 standard SW, all to the same pole; and group 4 (n=8), same as group 3 except 100 12-kV SW pretreatment. Mean+/-SD lesion size in group 1, first pole treated, was 0.66+/-0.82% of functional renal volume (FRV; P<0.05 versus 5.22+/-3.6% FRV with no pretreatment [NP]; 95% confidence interval [CI] -7.0 to -2.1) and 0.50+/-0.68% FRV in the opposite pole after 2000 standard SW (P<0.05 versus NP; 95% CI -9.4 to -0.08). Mean lesion size (first pole) in group 2 was 0.020+/-0.028% FRV (P<0.01 versus NP; 95% CI -9.2 to -1.2) and 0.43+/-0.54% FRV in the opposite pole after 2000 standard SW (P<0.05 versus NP; 95% CI -8.8 to -0.82). Same-pole SW (groups 3 and 4) also protected. Mean lesion sizes were 0.28+/-0.33% (P<0.01 versus NP; 95% CI -8.0 to -1.9) in group 3 and 0.39+/-0.48% FRV (P<0.01 versus NP; 95% CI -8.2 to -1.7) in group 4. It is concluded that the pretreatment protocol substantially limits the renal injury that normally is caused by SWL and occurs when the pretreatment and standard SW are applied to the same pole. The threshold for the protection may be <100 SW.
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Affiliation(s)
- Lynn R Willis
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, and Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, IN 46202, USA.
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Willis LR, Evan AP, Connors BA, Shao Y, Blomgren PM, Pratt JH, Fineberg NS, Lingeman JE. Shockwave lithotripsy: dose-related effects on renal structure, hemodynamics, and tubular function. J Endourol 2005; 19:90-101. [PMID: 15735392 DOI: 10.1089/end.2005.19.90] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Shockwave lithotripsy (SWL) predictably damages renal tissue and transiently reduces function in both kidneys. This study characterized the effects on renal function of a supraclinical dose of shockwaves (SWs) (8000) in porcine kidneys and tested the hypothesis that such excessive treatment would intensify and prolong the resulting renal impairment. MATERIALS AND METHODS Pigs aged 6 to 7 weeks were anesthetized and assigned to one of three groups. Groups 1 (N=8) and 2 (N=6) each received 8000 SWs at 24 kV (Dornier HM3) to the lower-pole calix of one kidney. Group 3 (7 pigs) received sham treatment. Renal function was monitored for the first 4 hours after SW treatment in Group 1 and for 24 hours in Group 2. Plasma renin activity was measured in Groups 2 and 3. RESULTS The renal lesions produced by 8000 SWs comprised 13.8%+/-1.4% of the renal mass. In the 4-hour protocol, this injury was associated with marked reduction of the glomerular filtration rate (GFR), renal plasma flow (RPF), and urinary sodium excretion in both kidneys, although fractional sodium excretion was reduced only in the shocked kidneys. In the 24-hour protocol, GFR and RPF remained below baseline in shocked kidneys at 24 hours. Evidence of progressive ischemic injury was noted in shocked tissue at 24 hours after SW treatment. CONCLUSIONS These findings support the hypothesis that the severity of the renal injury caused by SWL is related to the number of SWs administered and demonstrate the connection in this relation between renal structure and function.
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Affiliation(s)
- Lynn R Willis
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Park JK, Cui Y, Kim HJ, Oh HK, Koh GY, Cho KW. Activation of nitric oxide-cyclic guanosine monophosphate signaling in kidney by extracorporeal shock wave therapy. J Urol 2004; 170:2459-62. [PMID: 14634450 DOI: 10.1097/01.ju.0000094186.19728.c2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We defined whether extracorporeal shock wave therapy (ESWT) to the kidney activates the nitric oxide (NO)-cyclic 3',5'-guanosine monophosphate (cGMP) pathway. MATERIALS AND METHODS A total of 90 male rabbits were randomly divided into group 1--pretreated with normal saline, group 2--pretreated intravenously (i.v.) with Nomega nitro-L-arginine-methyl ester (NAME) (100 mg/kg), group 3--pretreated i.v. with NAME and L-arginine (300 mg/kg) with ESWT to 1 kidney, group 4--pretreated IV with ODQ (1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one) (20 microg/kg) and group 5--pretreated with normal saline with ESWT to the bladder. Plasma nitrite, NO metabolite and cGMP were analyzed in peripheral blood samples before, immediately after, and 30 and 60 minutes after ESWT. RESULTS ESWT to the kidney but not to the bladder caused an increase before, immediately after, and 30 and 60 minutes after ESWT in plasma nitrite in group 1 (186.1 +/- 20.6, 217.5 +/- 21.6, 241.9 +/- 28.4 and 230.5 +/- 25.3 nM) and group 5 (149.0 +/- 14.7, 155.6 +/- 18.4, 131.8 +/- 13.6 and 140.0 +/- 15.7 nM), and in cGMP in group 1 (24.2 +/- 1.9, 33.8 +/- 3.2, 32.9 +/- 2.2 and 29.4 +/- 1.9 pmol/ml) and group 5 (25.5 +/- 2.1, 27.5 +/- 2.5, 28.7 +/- 3.1 and 25.5 +/- 2.6 pmol/ml, respectively). In group 2 NAME significantly inhibited the production of nitrite (113.4 +/- 18.6, 118.2 +/- 19.9, 114.6 +/- 18.3 and 112.5 +/- 17.6 nM) and cGMP (19.4 +/- 2.6, 20.6 +/- 2.8, 19.3 +/- 2.7 and 18.6 +/- 2.6 pmol, respectively). In group 3 inhibited nitrite and cGMP production caused by NAME was recovered with L-arginine. In group 4 ODQ significantly inhibited cGMP production. CONCLUSIONS The results show that ESWT increases the level of NO and cGMP released by the kidney in an animal model.
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Affiliation(s)
- Jong Kwan Park
- Department of Urology, Chonbuk National University Medical School, Chonju, South Korea.
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Liu AS, Xie JX. Functional evaluation of normothermic ischemia and reperfusion injury in dog kidney by combining MR diffusion-weighted imaging and Gd-DTPA enhanced first-pass perfusion. J Magn Reson Imaging 2003; 17:683-93. [PMID: 12766898 DOI: 10.1002/jmri.10312] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate functional alterations of renal ischemia and reperfusion injury using MR diffusion-weighted imaging and dynamic perfusion imaging. MATERIALS AND METHODS Twelve dogs were randomly divided into four groups. Animal renal ischemia was respectively induced for 30 (group 1), 60 (group 2), 90 (group 3), and 120 (group 4) minutes by left renal artery ligation under anesthesia. Using a 1.5 T MR system, true-FISP, TSE, EPI, and DWI sequences were acquired in five different periods; specifically, pre-ischemia, onset-ischemia, late ischemia, onset-reperfusion, and post-reperfusion. Moreover, a turbo-FLASH sequence (TR/TE/TI/FA = 5.8/3.2/400 msec/10 degrees ) with a temporal resolution of 1.16 seconds was acquired. Signal intensity (SI) was measured in the cortex, outer medulla, and inner medulla of kidney. Apparent diffusion coefficient (ADC) values were calculated, and SI was plotted as a function of time. RESULTS In all animals, significant SI changes of the left kidney on T2/T2*WI were detected following ischemia-reperfusion insult compared to corresponding values of the right kidney. Following ligation, the ADC values decreased in all layers of the left kidney. Immediately after the release of ligation, ADC values in both outer and inner medulla of the left kidney remained lower than those of the right kidney in those animals which were induced with renal ischemia for 60, 90, and 120 minutes. In all groups, a uniphasic enhancement pattern was observed in the outer and inner medulla of the left kidney, accompanied by a decrease of the area under the curve. CONCLUSION Our results suggest that MR diffusion-weighted imaging and dynamic perfusion imaging are useful in identifying renal dysfunction following normothermic ischemia and reperfusion injury.
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Affiliation(s)
- Ai-Shi Liu
- Department of Radiology, Peking University Third Hospital, Beijing, Peoples Republic of China.
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Abstract
Magnetic resonance (MR) imaging is finding an ever-growing role in the evaluation of a wide range of conditions in the abdomen. No longer confined to problem solving regarding abnormalities in solid organs, such as the liver and kidneys, MR imaging is increasingly being applied to the evaluation of the pancreatic and biliary ductal systems and even the bowel. Recent technical advances in hardware and software have allowed the acquisition of MR images that are largely free of artifact secondary to bowel peristalsis or respiratory motion; images providing excellent anatomic detail can now be obtained routinely. Faster sequences have reduced image acquisition time, thereby improving patient acceptance and allowing more efficient utilization of machine time. New three-dimensional sequences allow rapid image acquisition, reducing section misregistration and motion artifact while improving multiplanar reformations. The potential of MR imaging to provide functional and anatomic information is intriguing, and new techniques, including diffusion and perfusion imaging, are being evaluated. This review considers the advances in imaging hardware and pulse sequence design that underlie the increasing role of MR imaging in evaluation of the abdomen and discusses evolving clinical applications.
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Affiliation(s)
- M T Keogan
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd, Boston, MA 02215, USA.
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17
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Abstract
Historically, the utilization of magnetic resonance imaging (MRI) in endourology has been limited. The availability of faster and stronger gradient systems has given rise to a number of data acquisition strategies that have significantly broadened the scope of MRI applications. These methods have led to the evaluation of anatomy and function using a single modality, and we describe our experience with MRI for comprehensive evaluation of the obstructed ureteropelvic junction. We also utilize these new imaging sequences in the investigation of alterated renal hemodynamics after extracorporeal shockwave lithotripsy and present our preliminary data on the application of MR perfusion imaging as a noninvasive technique for the evaluation of renal blood flow.
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Affiliation(s)
- A J Chan
- Division of Urology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA
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18
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Chan AJ, Prasad PV, Priatna A, Mostafavai MR, Sunduram C, Saltzman B. Protective effect of aminophylline on renal perfusion changes induced by high-energy shockwaves identified by Gd-DTPA-enhanced first-pass perfusion MRI. J Endourol 2000; 14:117-21. [PMID: 10772502 DOI: 10.1089/end.2000.14.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate regional renal hemodynamics in a noninvasive manner using gadolinium-DPTA magnetic resonance imaging (MRI) before and after extracorporeal shockwave lithotripsy (SWL). In addition, the renoprotective effect of intravenous aminophylline was evaluated on the perfusion on kidneys undergoing SWL. PATIENTS AND METHODS Ten randomly selected patients were evaluated for regional renal blood flow in the cortex and medulla with Gd-DTPA MRI studies within 2 weeks before and 4 hours after SWL. Five of these patients were treated with 500 mg of intravenous aminophylline 45 minutes prior to SWL. Renal hemodynamics were assessed utilizing relative perfusion indices (PI) calculated from signal intensity-v-time curves obtained from regions of interest (ROI). The ROI choice was based on the contrast-enhanced MRI images. Relative PIs of pre-SWL and post-SWL studies were compared in the first group of patients. Relative PIs of the treated kidney were compared with those of the contralateral kidney in the second group of patients, who received aminophylline. RESULTS In the group not treated with aminophylline, there was no significant difference in cortical perfusion before SWL (average PI -7+/-3%). However, after lithotripsy, there was a reduction of cortical flow (average PI 31+/-12%) in the treated kidney. In the group treated with aminophylline, renal hemodynamics study after SWL revealed no significant difference in relative perfusion (average PI -8+/-6%). Relative PIs of the medulla were small for all patients, but standard errors were large, indicating a wide range of values. CONCLUSIONS This study helps to establish reduced cortical flow after SWL and demonstrates that aminophylline attenuated this response in the kidneys subjected to lithotripsy. It appears that aminophylline administration causes no alteration in medullary blood flow.
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Affiliation(s)
- A J Chan
- Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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19
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Connors BA, Evan AP, Willis LR, Blomgren PM, Lingeman JE, Fineberg NS. The effect of discharge voltage on renal injury and impairment caused by lithotripsy in the pig. J Am Soc Nephrol 2000; 11:310-318. [PMID: 10665938 DOI: 10.1681/asn.v112310] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The present study was designed to determine the effects of shock wave voltage (kV) on lesion size and renal function induced by shock wave lithotripsy (SWL) in the 6- to 8-wk-old pig. Each SWL-treated pig received 2000 shock waves at 12, 18, or 24 kV to the lower pole calyx of one kidney. A group of sham SWL pigs served as time controls. Bilateral GFR, renal plasma flow (RPF), and para-aminohippurate (PAH) extraction were measured 1 h before and 1 and 4 h after SWL in all treated and sham animals. The kidneys were removed at the end of each experiment for morphometric analysis. The SWL-induced lesion increased significantly in size as shock wave energy was increased from 12 to 24 kV. PAH extraction, a measure of tubular function, was not significantly affected at 12 kV, was transiently reduced at 18 kV, and was reduced for the duration of the experiment at 24 kV. GFR and RPF, however, were significantly and similarly reduced at the 1 h post-SWL period at all three kilovolt levels. At the 4-h post-SWL period, both GFR and RPF had returned to baseline levels. Lesion size and tubular injury were correlated with changes in kilovoltage, while changes in renal hemodynamics were already maximal at the lowest discharge voltage. These findings suggest that renal microvessels are highly sensitive to shock waves and that frank injury to tubules and vessels may be more closely related to discharge energy than is renal blood flow.
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Affiliation(s)
- Bret A Connors
- Department of Anatomy, Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew P Evan
- Department of Anatomy, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lynn R Willis
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Philip M Blomgren
- Department of Anatomy, Indiana University School of Medicine, Indianapolis, Indiana
| | - James E Lingeman
- Methodist Hospital Research Institute, Clarian Health Partners, Indianapolis, Indiana
| | - Naomi S Fineberg
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Prasad PV, Cannillo J, Chavez DR, Pinchasin ES, Dolan RP, Walovitch R, Edelman RR. First-pass renal perfusion imaging using MS-325, an albumin-targeted MRI contrast agent. Invest Radiol 1999; 34:566-71. [PMID: 10485071 DOI: 10.1097/00004424-199909000-00003] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES MR angiography is proving to be a useful clinical study for the diagnosis of vascular disorders of renal arteries. However, its utility in terms of stenosis characterization is still limited. Renal perfusion could provide supplemental information that could allow for a comprehensive evaluation of renal artery stenosis by MR imaging. METHODS MS-325 is a small-molecule blood pool agent that reversibly binds with serum albumin and hence leads to higher relaxivity and longer residence times in the blood. In this study, the authors evaluated the use of MS-325 to perform first-pass perfusion imaging and contrast-enhanced MR angiography in the characterization of renal artery stenosis in an animal model. RESULTS Quantitative perfusion estimates were obtained in the renal cortex (258 +/- 19.8 mL/min/100 g) and are comparable to microsphere measurements (198 +/- 12.2 mL/min/100 g), given the practical constraints. Based on these measurements, perfusion showed minimal changes even when the diameter reductions reached 75%. CONCLUSIONS MS-325 could provide quantitative perfusion estimates that when combined with MR angiography may lead to comprehensive evaluation of renal artery stenosis.
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Affiliation(s)
- P V Prasad
- Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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Willis LR, Evan AP, Connors BA, Blomgren P, Fineberg NS, Lingeman JE. Relationship between kidney size, renal injury, and renal impairment induced by shock wave lithotripsy. J Am Soc Nephrol 1999; 10:1753-62. [PMID: 10446943 DOI: 10.1681/asn.v1081753] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The relationship between kidney size and impaired renal function induced by shock-wave lithotripsy (SWL) was examined in 6- and 10-wk-old anesthetized pigs. Each pig received 2000 shock waves, 24 kV, or sham SWL to the lower pole calyx of one kidney. Bilateral GFR, renal plasma flow (RPF), and para-aminohippurate extraction was measured 1 h before and 1 and 4 h after SWL. The kidneys were then removed for morphometric analysis. Mean kidney weights were 66.1+/-2.7 g (n = 9) and 103.1+/-3.3 g (n = 8) in the SWL groups, and 60.1+/-2.6 g (n = 9) and 82.3+/-4.0 g (n = 9) in the sham-SWL groups. SWL-induced lesions occupied a significantly greater volume of the small kidneys (6.1+/-1.7 vol % versus 1.5+/-0.2 vol% in the large kidneys). RPF was significantly reduced by SWL in small and large kidneys, but to a significantly greater extent in small kidneys. RPF was also significantly reduced in the contralateral kidneys of both groups, but only at 1 h after SWL. SWL significantly reduced GFR to similar degrees in both kidneys of both groups, regardless of kidney size. Para-aminohippurate extraction was likewise reduced to similar degrees in both groups, but this effect was evident only in the SWL-treated kidneys, and only in the pole to which the shock waves had been applied. The injury induced by SWL affected a larger fraction of small kidneys than large ones, and the renal vasoconstriction induced by SWL was greatest in small kidneys.
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Affiliation(s)
- L R Willis
- Department of Pharmacology and Toxicology, School of Medicine, Indiana University, Indianapolis 46202, USA.
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22
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Abstract
The introduction of shock wave lithotripsy into clinical practice revolutionized the management of urinary tract stone disease. As experience has been gained with its use, however, the limitations and adverse effects associated with it have been recognized.
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Affiliation(s)
- D A Tolley
- Scottish Lithotriptor Centre, Regional Department of Urology, Belfast City Hospital Trust, UK
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23
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Abstract
Availability of faster and stronger gradient systems have given rise to a multitude of fast MRI data acquisition strategies which have tremendously increased the scope of MRI applications. These have led to the realization of long desired comprehensive approaches to evaluate anatomy and function using a single modality. In this work, we describe some of our own experiences with functional evaluation of the kidneys using MRI. Examples that suggest the feasibility of comprehensive approaches for evaluation of renal disease are also provided. We also introduce BOLD renal MRI, a method that may allow basic understanding of human renal physiology and pathophysiology in a way that has not been previously possible.
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Affiliation(s)
- P V Prasad
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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