1813 EVALUATION OF RISK FACTORS FOR PROGNOSIS OF TEMPORARY RENAL IMPAIRMENT AFTER SECONDARY EXTRACORPORAL SHOCK WAVE LITHOTRIPSY (ESWL) IN RENAL STONE TREATMENT

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal III1 Apr 20101813 EVALUATION OF RISK FACTORS FOR PROGNOSIS OF TEMPORARY RENAL IMPAIRMENT AFTER SECONDARY EXTRACORPORAL SHOCK WAVE LITHOTRIPSY (ESWL) IN RENAL STONE TREATMENT Christian Weißflog, Sven Oehlschläger, and Manfred Wirth Christian WeißflogChristian Weißflog More articles by this author , Sven OehlschlägerSven Oehlschläger More articles by this author , and Manfred WirthManfred Wirth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1738AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES ESWL as primary treatment of renal stone disease leads traceable (animal experiment, change of tubulary enzymes of human kidneys) to temporary renal impairment. The correlation between age, comorbidic factors (hypertension, diabetes, chronic ischaemic heart disease) and elevated levels of retention parameters is well known. With respect to different treatment opportunities (ureterorenoscopic stone extraction, ureterolithotomy) a predictable model to calculate renal impairment prior to ESWL would be of pathbreaking interest. This might lead to an alternative therapy without or with less renal impairment. METHODS 111 patients were examined with primary ESWL. 63 underwent immediate secondary ESWL. We analysed for age, sex, body mass index, body surface, stone location (side; upper, medium and lower calyx, ureteral stones excluded), creatinine and GFR prior (0) and after first (1) and second ESWL (2), prior stone treatment, hypertension, diabetes, chronic ischaemic heart disease, flouroscopy time for stone localisation, amount and intensity of shock waves, stone size, sonografic skin-stone-distance, renal stasis and in situ DJ-uretercatheter. RESULTS There was a non-significant decrease between GFR 0 vs. GFR 1. The significant decrease of GFR 0 vs. GFR 2 (p<0.01, table 1) was correlated with sex, age and arterial hypertension. Patients with decrease > 6 points in GFR after secondary ESWL, can be predicted with the logit sum model. The probability of decreased GFR has been calculated by summing up the regression-coefficients (table 2) and including it into the following formula of the logit transformation: p = exp(logit sum)/(1+exp(logit sum)), result in percent. table 1 - GFR mean ± SD (ml/min/1,73m2) prior to ESWL (0) 98,7±22,5 after 1. ESWL (1) 97,5±20,6(p<0,08) after 2. ESWL (2) 93,4±21,1(p<0,01) table 2 - variable regression-coefficient p Intercept -4.5125 creatinine prior to ESWL 0.0317 0.0309 GFR prior to ESWL 0.0446 0.0023 BMI -0.1538 0.0472 hypertension 1.2910 0.0076 CONCLUSIONS The study showed a significant decrease of GFR after secondary ESWL. Patients at risk can be predicted by using our evaluated statistic model. Those patients might profit of a conditioning of renal function or an optimized treatment of hypertension prior to ESWL. Dresden, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e703-e704 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Weißflog More articles by this author Sven Oehlschläger More articles by this author Manfred Wirth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...