Effects of stone density on alteration in renal resistive index after extracorporeal shock wave lithotripsy for non-obstructed kidney stones

Year 2023, , 174 - 177, 12.01.2023

Ahmet Keleş , Ahmet Karakeci , Tunç Ozan , Ercan Yuvanç

https://doi.org/10.32322/jhsm.1212923

Abstract

Aim: The doppler-based renal resistive index is a recently proposed technique for measuring changes in renal perfusion and predicting acute kidney damage. The purpose of this study was to look at the influence of stone density on the renal resistive index (RI) after extracorporeal shock wave lithotripsy (ESWL) in patients with non-obstructed kidney stones.
Material and Method: Between May 2020 and July 2021, 48 consecutive patients with unilateral renal calculi of ≤ 20 mm were treated with ESWL monotherapy. The patients' non-contrast computed tomography (NCCT) images were processed and grouped into two groups using Hounsfield units (HU) (Group 1, n=27, ≤ 1000 HU; Group 2, n=21, > 1000 HU). The same radiologist performed Doppler ultrasonography on all cases before, one hour, and one week following ESWL. Measurement of the RI taken in the remote region (at least 20 mm from the stones). Patient age, gender, BMI, stone laterality, stone size, and stone position were investigated as potential predictors.
Results: The average stone size for Group 1 was 11.7±3.3 mm and 12.1±2.8 mm for Group 2. The mean RI values before ESWL for Group 1 and Group 2 were 0.54 and 0.53, respectively. On comparing the pre-treatment data with the 1 hour after ESWL, a statistically significant increase was recorded in the RI value for both groups. However, there was no significant difference in RI values between groups 1 and 2 1 hour and 1 week following lithotripsy therapy. After one week, the mean RI returned to pretreatment levels, according to a follow-up doppler investigation. There was no association between stone density and RI (p > 0.05).
Conclusion: High stone densities detected with NCCT were not associated with a significant change in RI. Post-ESWL therapy alterations are present and reversible one week after the treatment.

Keywords

Resistive index, stone, kidney

References

• Miller NL, Lingeman JE. Management of kidney stones. BMJ 2007; 334: 468-72.
• Liu Z, Man L. Impacts of the COVID-19 outbreak on visits and treatments for patients with ureteral stones in a general hospital emergency department. Urologia 2021; 88: 232-6.
• Galvin DJ, Pearle MS. The contemporary management of renal and ureteric calculi. BJU Int 2006; 98: 1283-8.
• Turkay R, Inci E, Bas D, Atar A. Shear wave elastographic alterations in the kidney after extracorporeal shock wave lithotripsy. J Ultrasound Med 2018; 37: 629-34.
• Lee YJ, Oh SN, Rha SE, Byun JY. Renal trauma. Radiol Clin North Am 2007; 45: 581-92.
• McAteer JA, Evan AP. The acute and long-term adverse effects of shock wave lithotripsy. Semin Nephrol 2008; 28: 200-13.
• Baumgartner BR, Dickey KW, Ambrose SS, Walton KN, Nelson RC, Bernardino ME. Kidney changes after extracorporeal shock wave lithotripsy: appearance on MR imaging. Radiology 1987; 163: 531-4.
• Newman R, Hackett R, Senior D, et al. Pathologic effects of ESWL on canine renal tissue. Urology 1987; 29: 194-200.
• Tublin ME, Bude RO, Platt JF. Review. The resistive index in renal Doppler sonography: where do we stand? AJR Am J Roentgenol 2003; 180: 885-92.
• Tipisca V, Murino C, Cortese L, et al. Resistive index for kidney evaluation in normal and diseased cats. J Feline Med Surg 2016; 18: 471-5. 
• Bres-Niewada E, Dybowski B, Radziszewski P. Predicting stone composition before treatment - can it really drive clinical decisions? Cent European J Urol 2014; 67: 392-6.
• Turk C, Skolarikos A, Neisius A, et al. EAU guidelines on urolithiasis. In: EAUG Office, editor. EAU guidelines. Edn published as the 35th EAU Annual Meeting, Amsterdam. Arnhem, the Netherlands: European Association of Urology Guidelines Office; 2020.
• Hocaoglu E, Inci E, Aydin S, Cesme DH, Kalfazade N. Is quantitative diffusion-weighted MRI a valuable technique for the detection of changes in kidneys after extracorporeal shock wave lithotripsy? Int Braz J Urol 2015; 41: 139–46.
• Derchi LE, Martinoli C, Pretolesi F, et al. Renal changes from extracorporeal shock-wave lithotripsy: evaluation using Doppler sonography. Eur Radiol 1994;  4, 41–4.
• Knapp R, Frauscher F, Helweg G, et al. Age-related changes in resistive index following extracorporeal shock wave lithotripsy. J Urol 1995; 154: 955-8.
• Janetschek G, Frauscher F, Knapp R, Höfle G, Peschel R, Bartsch G. New onset hypertension after extracorporeal shock wave lithotripsy: age related incidence and prediction by intrarenal resistive index. J Urol 1997; 158: 346-51. 
• Nazaroglu H, Akay AF, Bükte Y, Sahin H, Akkus Z, Bilici A. Effects of extracorporeal shock-wave lithotripsy on intrarenal resistive index. Scand J Urol Nephrol 2003; 37: 408-12.
• El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ. A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography. Eur Urol 2007; 51: 1688-94.