Morphological Pathomechanism Following Extracorporeal Shock Wave Lithotripsy in Rat Kidneys
Between 500 and 5,000 shock waves were administered to 50 Wistar rats, using the modified Dornier HM3 system with the SG 40 shock wave generator. The animals were sacrificed at 24 hours, 7 days, 14 days, or 35 days following treatment. Histological examination, scanning electron microscopy (SEM) and magnetic resonance imaging (MRI) were used to evaluate acute and long-term effects after extracorporeal shock wave lithotripsy (ESWL). Acute morphological changes such as glomerular bleeding, tubular dilatation, atrophy, and partial necrosis occurred immediately after ESWL. SEM revealed a loss of microvilli and cilia. There was generally restitutio ad integrum of these diffuse lesions. The extent of long-term renal lesions was determined by the following pathomechanism: rupture of the arcuate veins occurring in response to ESWL, especially in the area of the corticomedullary junction, resulted in interstitial bleeding demonstrable by MRI; in long-term groups, these hematomas developed into interstitial fibroses with segmental renal scars. The blood supply was reduced, and secondary lesions such as glomerular-tubular atrophy and sclerosis followed. The degree to which long-term renal lesions resulted was determined by the extent of these changes, which were shock wave dose dependent up to a dose of 2,000 shock waves.
KeywordsShock Wave Shock Wave Lithotripsy Extracorporeal Shock Wave Lithotripsy Shock Wave Generator Secondary Lesion
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