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Shock Wave Blasting Treatment of Kidney Stones Increases Risk of Diabetes and High Blood Pressure (Hypertension) - Lithotripsy

April 10th 2006

Shock Wave Blasting Treatment of Kidney Stones Increases Risk of Diabetes and High Blood Pressure (Hypertension) - Lithotripsy

Kidney and Bladder

The use of shock waves to break up impassable kidney stones significantly increased the risk for diabetes and hypertension later in life.  Mayo Clinic researchers conducted a study concerning this common treatment that emits shockwaves to break the kidney stone into smaller “sandlike” pieces which are able to pass spontaneously with the urine, usually within a month. 

According to Amy Krambeck, MD, “This is a completely new finding. This opens the eyes of the world of urology to the fact that hypertension and diabetes are potential side effects. We can't say with 100 percent certainty that the shock wave treatment for the kidney stones caused diabetes and hypertension, but the association was very strong. The risk of developing diabetes after shock wave lithotripsy is almost four times the risk of people with kidney stones treated with medicine, and the risk of developing hypertension is one and one-half times, which is a significant risk increase."  Amy is a clinical urology resident at the Mayo Clinic and lead author of the study. 

 

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."

 
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By Dan Wilson
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Copyright 2005 Best Syndication                   Last Updated Saturday, July 10, 2010 09:51 PM