1569 A COMPARISON OF SHOCKWAVE INDUCED RENAL INJURY AT DIFFERENT DELIVERY RATES WITHIN A SAME SUBJECT

Article Outline

• INTRODUCTION AND OBJECTIVES
• METHODS
• RESULTS
• CONCLUSIONS
• Copyright

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INTRODUCTION AND OBJECTIVES 

Animal models have demonstrated that stone fragmentation is improved by slower shockwave delivery rate. The in vivo effect of different shock wave (SW) delivery rates on renal damage was not known.Therefore, we would like To compare the degree of renal trauma of SWL within the same subject treated at different SW delivery rates by in a clinical studytrial.

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METHODS 

This study is designed aswas a randomized two-sequence, two-period 2 x2 crossover clinical trial. Adult patients with solitary renal stones of size 5-20mm were treated byrandomized with SWL treatment of Sonolith Vision (Technomed, France). Patients was first randomized to receive either treatment at 60 SWs/min in the first session of SWL would be 120 SWs/min. Decision for retreatment was decided at the end of 12-week follow-up. If patient required re-treatment, the second treatment would be performed at the other delivery rate (cross-over). During all treatment, spot urine was collected before SWL (baseline), immediately, Day-2, Day-7 and 4-weeks post-treatment. Degree of renal injury was assessed by the urinary level of Interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL) and N-acetyl-£]-D-glucosaminidase (NAG). The values were then compared.

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RESULTS 

19 patients have been recruited, with 12 patients treated with 60 SWs/min first (Group A) and 7 patients with 120 SWs/min first (Group-B). All second treatments were performed after 12 weeks with maker level back to baseline level. All three markers were increased significantly at immediate post-treatment when compared to baseline levels (p<0.05). Form the result of IL-18 and NGAL level, there is a trend in suggesting that slower shockwave delivery rate result in greater renal injury. Table below shows the change in biomarker levels in both groups.

Biomarker	60 SWs/min (units/mole creatinnine)	120 SWs/min(units/mole creatinnine)
NAG	0.9511 ± 1.058 mIU	1.042 ± 1.542 mIU
IL-18	0.0324 ± 0.0687 mg	0.0153 ± 0.0243 mg
NGAL	6.551 ± 6.573 g	3.948 ± 6.039 g

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CONCLUSIONS 

Slower shockwave delivery rate may not protect against SWL induce renal injury. Further study is needed.