Monday, June 4, 2012

Clinical Case 57: Answers and Summary


TRUE OR FALSE: LITHOTRIPSY CONCURS A HIGH RISK OF LIFETIME DEVELOPMENT OF HYPERTENSION AND DIABETES.

What is the data on this? Does Shock wave Lithotripsy cause high risk of HTN and Diabetes?

Human studies have shown that this therapy can leading to hemorrhaging and edema in the kidney.  As the dose increases, perhaps chronic scarring might ensue. Elve et al prospectively studied 228 patients with small calculi < 15nm and a control group. Followed for 2.2 years, found that there was no statistical significance in hypertension incidence. 
Another group found similar results. In a report of 578 patients who had undergone this, att a mean follow-up of 19 years, hypertension was significantly more prevalent in the lithotripsy group.Mayo Clinic researchers reported in the 2006  that patients who undergo this procedure are nearly four times more likely to develop diabetes and face a nearly 50 percent higher risk of high blood pressure over the following decades than those getting alternative treatment( retrospective study). In a more recent study, in a large, population-based cohort, the long-term risk of developing DM was not increased in persons who underwent this procedure to treat their kidney stones. Lithotripsy using the HM-3 was not associated with increased DM or hypertension in a Canadian study from 2011 as well.

Perhaps the jury is still out on this association. 

Here are a few references:

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