Yonsei Med J.  2012 Jul;53(4):708-714. 10.3349/ymj.2012.53.4.708.

Removal of Kidney Stones by Extracorporeal Shock Wave Lithotripsy Is Associated with Delayed Progression of Chronic Kidney Disease

• Yoo DE
• Han SH
• Oh HJ
• Kim SJ
• Shin DH
• Lee MJ
• Yoo TH
• Kang SW
• Choi KH

• KMID: 1716867
• DOI: http://doi.org/10.3349/ymj.2012.53.4.708

Abstract

PURPOSE
This study aimed to elucidate whether stone removal by extracorporeal shock wave lithotripsy (ESWL) is associated with delayed chronic kidney disease (CKD) progression.
MATERIALS AND METHODS
We conducted a retrospective analysis of 131 nephrolithiasis patients with stage 3 and 4 CKD. We collected baseline clinical and laboratory data, kidney stone characteristics, and history of receiving ESWL. We classified study patients into two groups according to whether they underwent ESWL or not (Non-ESWL group vs. ESWL group). We initially compared annual estimated glomerular filtration rate (eGFR) changes of Non-ESWL group with those of ESWL group before undergoing ESWL. In the next step, we sought to compare annual eGFR changes in the same patients before and after ESWL. Finally, we compared annual eGFR changes between success and failure groups among patients undergoing ESWL.
RESULTS
The mean age of the patients was 62 years and 72.5% were male. The mean observation period was 3.2 years. Non-ESWL group and ESWL group before undergoing ESWL showed similar annual eGFR changes (-1.75+/-6.5 vs. -1.63+/-7.2 mL/min/1.73 m2/year, p=0.425). However, eGFR declined slower after undergoing ESWL than before ESWL (annual eGFR changes, -0.29+/-6.1 vs. -1.63+/-7.2 mL/min/1.73 m2/year, p<0.05). In addition, among patients in ESWL group, eGFR declined faster in the failure group than in the success group (annual eGFR change, -1.01+/-4.7 vs. -0.05+/-5.2 mL/min/1.73 m2/year, p<0.05).
CONCLUSION
Our results suggest that stone removal by ESWL is associated with delayed deterioration of renal function in CKD patients with nephrolithiasis.

Keyword

Nephrolithiasis; chronic kidney disease; extracorporeal shock wave lithotripsy (ESWL); glomerular filtration rate (GFR)

MeSH Terms

Adult
Aged
Aged, 80 and over
Chronic Disease/*prevention & control
Female
Glomerular Filtration Rate/physiology
Humans
Kidney Calculi/*therapy
Kidney Diseases/*prevention & control
Lithotripsy/*methods
Male
Middle Aged
Retrospective Studies

Figure

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  Fig. 1 Flow diagram indicating patient recruitment and exclusion. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; CT, computed tomography; US, ultrasonography.

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  Fig. 2 Comparison of annual eGFR decline between ESWL and Non-ESWL group. ESWL, extracorporeal shock wave lithotripsy; eGFR, estimated glomerular filtration rate.

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