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Five anesthetized dogs were studied for 4 to 5 hours after administration of extracorporeal shock waves to one kidney, the contralateral organ serving as control. Repetitive major doses of the nonionic monomeric radiographic contrast medium (CM) iohexol were injected intravascularly before and after application of the extracorporeal shock waves for further provocation of kidney function. Urinary excretion of electrolytes, N-acetyl-beta-glucosaminidase (NAG) and kallikrein, clearances of creatinine, inulin and para-amino-hippuric acid (PAH), serum aldosterone level and plasma renin activity (PRA) were determined. On the exposed side there was a significant fall in urinary osmolality. Effective renal plasma flow (ERPF) was reduced and glomerular filtration rate (GFR) was unchanged; thus filtration fraction (FF) was increased. Extraction of PAH was reduced, and true renal plasma flow was unchanged. Urinary osmolality on the control side was unchanged. There was a fall in ERPF and increased GFR; therefore, FF increased. The mean rise of PRA in the exposed kidney was significant after shock waves. Urine volume and urinary excretion of electrolytes and kallikrein were stable bilaterally. Relating the results to those obtained in identical canine experiments without CM, simultaneous administration of CM does not seem to significantly influence the changes in kidney function parameters caused by extracorporeal shock waves in the dog.

Seventeen patients were subjected to analysis of various renal functional parameters before and after extracorporeal shock wave lithotripsy (ESWL) for renal stones. Thirteen patients were observed at 2 weeks and 3 months. Glomerular filtration rate (GFR) was not influenced by ESWL as based on unchanged serum levels of creatinine, beta 2-microglobulin and creatinine clearance. A significant increase in urinary excretion of beta 2-microglobulin, N-acetyl-beta-glucosaminidase and alkaline phosphatase, with return to pre-treatment values within 4 to 5 days, reflected transient disturbances in proximal tubular function. Urinary albumin excretion was increased 0-24 h after ESWL. No significant alterations were observed in plasma renin activity or serum aldosterone due to ESWL. Serum lactic dehydrogenase remained significantly increased for 2 weeks. In addition, significant changes in several blood and urine parameters were caused by immersion in water and intravenous infusions during treatment and were not specifically due to ESWL.

Twelve consecutive patients with a solitary functioning kidney were treated for renal stone by extracorporeal shock wave lithotripsy (ESWL*) with the modified Dornier HM3 lithotriptor and studied for 3 days after treatment. Urinary excretion of electrolytes, N-acetyl-beta-glucosaminidase (NAG), alkaline phosphatase, kallikrein, glycosaminoglycans, albumin and beta 2-microglobulin, and clearances of creatinine, inulin and para-aminohippuric acid were determined, as were serum levels of creatinine, urea, beta 2-microglobulin and aldosterone, and plasma renin activity. Urinary flow rate, free water clearance, and urinary excretion of NAG, kallikrein and beta 2-microglobulin were significantly increased 0 to 24 hours after ESWL. The urinary excretions of alkaline phosphatase, albumin and glycosaminoglycans were unchanged. Glomerular filtration rate was significantly decreased and effective renal plasma flow was unchanged. Filtration fraction was stable. Serum lactic dehydrogenase increased significantly after ESWL and remained high through the period of observation. Serum levels of creatinine, beta 2-microglobulin and aldosterone were unaltered. A decrease in plasma renin activity immediately after treatment is explained by the water immersion and the extracellular volume expansion during treatment.

The acute effects of extracorporeal shock waves on renal morphology were studied by light and electron microscopy in 14 dogs. One kidney received an average clinical number of exposures, the nonexposed, contralateral kidney serving as control. The original Dornier HM-3 generator was used in 3 animals, the modified version in 11. Intravascular radiographic contrast medium was administered in five animals. Damage was observed in all exposed kidneys, none in the contralateral control kidney. The effects were characterized by renal and perirenal hemorrhage and edema, parenchymal hemorrhagic foci with tissue destruction, often extending from cortex to medulla. In the nearby regions there was endothelial cell damage in arteries, veins and glomerular capillaries. Breaks in the wall of these vessels were detected with platelet plug formations and thrombi. In glomeruli, breaks of Bowman's capsule and epithelial cell damage with loss of foot processes were observed. A wide range of tubular cell damage was demonstrated, ranging from vacuolization to complete necrosis. Tubular lumina were filled with red cells, indicating renal origin of hematuria. The tissue damage was less pronounced in kidneys exposed to the modified lithotriptor than to the original. No difference in the quantity or quality of damage was detected whether radiographic contrast medium was administered or not.

Nine anesthetized dogs were studied for four to five hours after administration of extracorporeal shock waves to one kidney, the contralateral organ serving as control. Urinary excretion of electrolytes, N-acetyl-beta-glucosaminidase (NAG) and kallikrein, clearances of creatinine, inulin and para-amino-hippuric acid (PAH), serum aldosterone level and plasma renin activity (PRA) were determined. On the exposed side there was a significant increase in urinary flow and urinary NAG excretion, and a significant fall in urinary osmolality. Effective renal plasma flow (ERPF) was reduced and glomerular filtration rate (GFR) unchanged, thus filtration fraction (FF) was increased. Extraction of PAH was significantly reduced compared with the control kidney. On the control side there was a significant increase in urinary flow and excretion of electrolytes, and a significant fall in urinary osmolality. GFR was increased and ERPF unchanged. FF therefore increased also on this side. The mean rise of PRA in the exposed kidney was higher than in the control kidney, the difference being not significant (p = 0.09). Our results may indicate a triggering of the renin-angiotensin system, and an effect on proximal tubular function following exposure of extracorporeal shock waves.