Abstract
An animal model has been developed to compare the biologic effects of various stone treatment modalities on renal and perirenal tissue. The pig (Suis scrafus) was chosen because its renal anatomy and physiology (including the renin-angiotensin system) are similar to those of humans and because its blood pressure regulation has been well characterized. An indwelling line was implanted in the right carotid artery for blood pressure measurement. None of the treatments (unilateral extracorporeal shock wave lithotripsy [ESWL] with 2000 or 4000 shock waves; percutaneous nephrostomy; open surgery) produced a lasting change in the glomerular filtration rate. Whereas neither 2000 shock waves nor open surgery produced a significant change in the blood pressure, 4000 shock waves caused a significant rise in blood pressure that was reversed by removal of the treated kidney; and percutaneous nephrostomy caused a slight although significant increase in blood pressure that was not reversed by nephrectomy. Although this was only a pilot study designed to test the feasibility of the model, it is significant that nephrogenic hypertension could be created by supraphysiologic doses of shock waves. The use of MRI proved helpful in detecting subclinical alterations in renal and perirenal morphology after all types of treatment. This model should be valuable in defining the roles and effects of stone treatments.
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