RESUMEN
In order to study the effects of high energy shock wave exposure on the kidney in extracorporeal shock wave lithotripsy (ESWL) using Dornier HM3, renal hemodynamics and renal function before and after ESWL were analyzed by 99mTc-DTPA renoscintigraphy. Various urinary enzyme activities (LDH, GOT, GPT, NAG, gamma-GTP) and low molecular protein concentrations (alpha 1-microglobulin, beta 2-microglobulin) before and after ESWL were also compared. In the early phase of the renoscinitgram obtained in the 1st min after injection of 99mTc-DTPA, the time required to reach maximum radioactivity was significantly prolonged after ESWL in both the affected and contralateral kidney. This indicated that renal blood flow decreased in both the affected and contralateral kidney immediately after ESWL. An analysis of the 30-min renoscintigram showed that urinary clearance was delayed in the affected kidney in spite of no overt obstruction due to stone fragments. As for urinary enzyme activities and low molecular protein concentrations, they were standardized by urinary creatinine concentration measured at the same time. Urinary LDH, GOT, GPT and NAG activities remarkably increased on the day of ESWL followed by a decrease close to pretreatment levels on the 4th day, though these levels were still significantly higher than pretreatment levels. Urinary gamma-GPT activity was significantly higher than the pretreatment level only on the day of ESWL. Urinary alpha 1-microglobulin and beta 2-microglobulin concentrations significantly increased on the day of ESWL and were still high on the 4th day.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Cálculos Renales/terapia , Riñón/fisiopatología , Litotricia/efectos adversos , Acetilglucosaminidasa/metabolismo , Adulto , Alanina Transaminasa/metabolismo , alfa-Globulinas/orina , Aspartato Aminotransferasas/metabolismo , Femenino , Hemodinámica , Humanos , Riñón/irrigación sanguínea , Riñón/diagnóstico por imagen , L-Lactato Deshidrogenasa/metabolismo , Masculino , Persona de Mediana Edad , Inhibidores de Proteasas/orina , Cintigrafía , Pentetato de Tecnecio Tc 99m , Microglobulina beta-2/orinaRESUMEN
The kidney stone of less than 2 cm can be effectively treated by extracorporeal shock wave lithotripsy (ESWL) using a Dornier kidney lithotripter HM3 without any complication that might need other therapy. However, in the case of a large kidney stone and ureteral stone, there are some difficulties in the treatment with ESWL. To obtain better results for these stones with a Dornier kidney lithotripter HM3, in the patient having a large stone a double-J stent was placed and ureteral catheter was indwelling for the ureteral stone before ESWL. In some cases high frequency positive pressure ventilation (HFPPV) was applied to make respiratory movement of the stone minimum. An indwelling double-J stent can significantly decrease the necessity of auxiliary treatment and the incidence of high fever attack. Manipulation of a ureteral stone with a ureteral catheter did not facilitate stone disintegration, and also the success rate as compared with in situ ESWL. HFPPV can decrease the stone movement within 2 mm judged on the X-ray monitor and increase the effectiveness of the shock wave on the stone, leading to minimize not only shock wave dose but also side effects from shock wave exposure.