<b>Purpose:</b> Pretreating a pig kidney with 500 low energy shock waves (SWs) before delivering a clinical dose of SWs (2000 SWs, 24 kV, 120 SWs/min) has been shown to significantly reduce the size of the hemorrhagic lesion produced in that treated kidney, compared to a protocol without pretreatment. However, since the time available for patient care is limited, we wanted to determine if fewer pretreatment SWs could be used in this protocol. As such, we tested if pretreating with 300 SWs can initiate the same reduction in renal lesion size as has been observed with 500 SWs. <b>Materials and Methods:</b> Fifteen female farm pigs were placed in an unmodified Dornier HM-3 lithotripter where the left kidney of each animal was targeted for lithotripsy treatment. The kidneys received 300 SWs at 12 kV (120 SWs/min) followed immediately by 2000 SWs at 24 kV (120 SWs/min) focused on the lower pole. These kidneys were compared to kidneys given a clinical dose of SWs with 500 SWs pretreatment, and without pretreatment. Renal function was measured both before and after SW exposure, and lesion size analysis was performed to assess the volume of hemorrhagic tissue injury (% functional renal volume, FRV) created by the 300 SW pretreatment regimen. <b>Results:</b> GFR fell significantly in the 300 SW pretreatment group by 1 hour after lithotripsy treatment. For most animals, low-energy pretreatment with 300 SWs significantly reduced the size of the hemorrhagic injury (to 0.8±0.4%FRV) compared to the injury produced by a typical clinical dose of SWs. <b>Conclusions:</b> The results suggest that 300 pretreatment SWs in a voltage ramping treatment regimen can initiate a protective response <b>in the majority of treated kidneys</b> and significantly reduce tissue injury in our model of lithotripsy injury.
Journal of endourology / Endourological Society. 2016 Jun 15 [Epub ahead of print]
Bret A Connors, Andrew P Evan, Rajash K Handa, Philip M Blomgren, Cynthia D Johnson, Ziyue Liu, James E Lingeman
Indiana University School of Medicine, Anatomy and Cell Biology , MS-0051 , 635 Barnhill Drive , Indianapolis, Indiana, United States , 46202 ; ., Indiana University School of Medicine, Anatomy and Cell Biology, Indianapolis, Indiana, United States ; ., Indiana University School of Medicine, Anatomy & Cell Biology, Indianapolis, Indiana, United States ; ., Indiana University School of Medicine, Anatomy and Cell Biology, Indianapolis, Indiana, United States ; ., Indiana University School of Medicine, Anatomy and Cell Biology, Indianapolis, Indiana, United States ; ., Indiana University School of Medicine, Biostatistics, Indianapolis, Indiana, United States ; ., Methodist Hospital Institute for Kidney Stone Disease, 1801 North Senate Blvd., Suite 220, Indianapolis, Indiana, United States ; .