The procedure, called shock wave lithotripsy, has been used for
decades. The Mayo researchers reviewed the charts of 630 patients that
were treated with shock wave lithotripsy in 1985. They sent those
patients that were still alive a questionnaire and almost 60%
responded.
The researchers matched up those that had the procedure with those
patients similar in age, gender and initial time of seeing a urologist
for kidney stones, that received a different treatment, or medicine.
The researchers found that nineteen years after the treatment, those
that had lithotripsy had 3.75 times the risk of having diabetes as those
given the other kidney stone treatment.
Interestingly, the degree of the increased risk was related to the
number and intensity of shocks administered. Those treated with
lithotripsy also had 1.47 times the risk of having hypertension (high
blood pressure) than those who received the other kidney stone
treatment; risk was highest for those who had both kidneys treated,
according to the Mayo Clinic researchers.
So why would this increase the risk for hypertension and diabetes? The
researchers hypothesize that the increase in risk for diabetes
associated with shock wave therapy for kidney stones relates to damage
inflicted to the pancreas. This was a previously known risk of
lithotripsy, which may affect the islet cells in the pancreas that make
insulin.
The increased risk for hypertension may be related to scarring, which
the treatment may cause to the kidneys. This could alter the secretion
of hormones centered in the kidneys like rennin, which influence blood
pressure.
Drs. Krambeck and Joseph Segura, M.D., Mayo Clinic urologist and study
investigator, say that they continue to use shock wave treatment, among
other alternative treatments for kidney stones. Dr. Segura said
“Despite the risks, shock wave therapy still can save the day for
patients, and it would be a mistake to put it on the shelf.”
The researchers indicate that they now counsel patients about the
potential risk for diabetes and hypertension prior to shock wave
treatment. The researchers stress the need for kidney stone patients and
their physicians to weigh the pros and cons of shock wave treatment
according to individual situations. "It's a trade-off about whether the
risks are worth taking," Dr. Segura said. "We're assuming doing nothing
is not the right thing to do for patients. You have to look at it in
terms of treatment alternatives -- percutaneous stone removal [removing
a kidney stone through a small incision in the patient's back using an
instrument called a nephroscope] or ureteroscopy [snaring a stone with a
small instrument passed into the ureter through the bladder and then
breaking up the stone with ultrasound or laser energy] -- each of which
has its own set of risks."
By Dan Wilson
Best Syndication
Books
on Diabetes
Keywords an misspellings: diabets suger
blode bloode diabetec biabetes
RSS Feed to our Heart/Lung News
