Reduction of Shock Wave-Induced Tubular Alteration by Fosfomycin

Abstract

Several investigations have shown that shock wave lithotripsy (SWL) can impair renal tubule function. Recently, we established an in vitro model using cultured Madin Darby canine kidney (MDCK) cells. In this model, an increase of lactic dehydrogenase (LDH) and aspartate transaminase (AST [SGOT]) concentrations in the culture medium could be demonstrated as an indication of tubular damage after shock wave exposure. In the present study, we examined the influence of fosfomycin on shock wave-induced tubular damage. This agent is known to have a protective effect against drug-induced nephrotoxicity. Suspensions of MDCK cells (70 x 106/ml) in filled small containers were exposed to shock waves (Dornier HM 4; 18 kV) either with or without fosfomycin added to the culture medium (100 μg/ml). Each series consisted of four groups of six containers each, which were exposed to either 256,128,64, or 0 impulses. In the control series, LDH and AST concentrations increased after SWL in a dose-dependent way. Although the AST increase was not influenced by fosfomycin, the LDH rise was significantly lower in the fosfomycin group. Our results indicate a protective effect of fosfomycin from shock-wave induced tubular damage in vitro. Further studies must be done to show whether fosfomycin is capable of reducing shock wave damage in vivo as well.