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Medicineworld.org: Shock Wave Therapy For Kidney Stones May Increase Risk Of Diabetes

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Shock Wave Therapy For Kidney Stones May Increase Risk Of Diabetes

Shock Wave Therapy For Kidney Stones May Increase Risk Of Diabetes
Mayo Clinic scientists are sounding an alert about side effects of shock wave lithotripsy: in a research study, they found this common therapy for kidney stones to significantly increase the risk for diabetes and high blood pressure during the later part of life. Risk for diabetes was correlation to the intensity of the therapy and quantity of the shock waves administered; high blood pressure was correlation to therapy of stones in both kidneys.

Shock wave lithotripsy uses shock waves to break up an impassable kidney stone into smaller, sandlike pieces which can be passed spontaneously, commonly within a month. The patient and the lithotriptor that emits the shock waves are placed in a water bath. Water allows easier conduction of the shock waves through the patient's tissue and precise focus on the kidney stone.

"This is a completely new finding," says Amy Krambeck, M.D., Mayo Clinic urology resident and lead study investigator. "This opens the eyes of the world of urology to the fact that high blood pressure and diabetes are potential side effects. We can't say with 100 percent certainty that the shock wave therapy for the kidney stones caused diabetes and hypertension, but the association was very strong. The risk of developing diabetes after shock wave lithotripsy is almost four times the risk of people with kidney stones treated with medicine, and the risk of developing high blood pressure is one and one-half times, which is a significant risk increase."

The study, which is the first examination of the effects of shock wave lithotripsy over the long term, involved reviewing charts of 630 patients treated with shock wave lithotripsy in 1985 at Mayo Clinic. The scientists sent those still alive a questionnaire; almost 60 percent responded. The scientists matched the patients treated with lithotripsy to patients similar in age, gender and initial time of seeing a urologist for kidney stones who received a different therapy, medicine. Nineteen years post-treatment, those treated with lithotripsy had 3.75 times the risk of having diabetes as those given the other kidney stone therapy. The degree of increased risk rose with greater number and intensity of shocks administered. Those treated with lithotripsy also had 1.47 times the risk of having high blood pressure -- hypertension -- than those who received the other kidney stone therapy; risk was highest for those who had both kidneys treated.

The scientists hypothesize that the increase in risk for diabetes associated with shock wave treatment for kidney stones relates to damage inflicted to the pancreas, a previously known risk of lithotripsy, which may affect the islet cells in the pancreas that make insulin. They believe the increased risk for high blood pressure may relate to scarring, which the therapy may cause to the kidneys and could alter the secretion of hormones centered in the kidneys like renin, which influence blood pressure.

Drs. Krambeck and Joseph Segura, M.D., Mayo Clinic urologist and study investigator, say that they continue to use shock wave therapy, among other alternative therapys for kidney stones.

"Despite the risks, shock wave treatment still can save the day for patients, and it would be a mistake to put it on the shelf," says Dr. Segura.

The scientists indicate that they now counsel patients about the potential risk for diabetes and high blood pressure previous to shock wave therapy.

Dr. Segura stresses the need for kidney stone patients and their physicians to weigh the pros and cons of shock wave therapy as per individual situations. "It's a trade-off about whether the risks are worth taking," he says. "We're assuming doing nothing is not the right thing to do for patients. You have to look at it in terms of therapy alternatives -- percutaneous stone removal [removing a kidney stone through a small incision in the patient's back using an instrument called a nephroscope] or ureteroscopy [snaring a stone with a small instrument passed into the ureter through the bladder and then breaking up the stone with ultrasound or laser energy] -- each of which has its own set of risks."

The Mayo Clinic scientists examined the long-term effects of lithotripsy for patients treated with a 1985 lithotriptor, one of the early models, in this study. Drs. Krambeck and Segura say additional research studies, including research on newer machines and different models, are needed on shock wave treatment and risk for diabetes and high blood pressure during the later part of life.

Previous to age 70, approximately 10 percent of men and 5 percent of women will experience a kidney stone, as per the National Institutes of Health. About 1 million people in the United States have had shock wave lithotripsy, says Dr. Segura.



Posted by: JoAnn    Source




Did you know?
Mayo Clinic scientists are sounding an alert about side effects of shock wave lithotripsy: in a research study, they found this common therapy for kidney stones to significantly increase the risk for diabetes and high blood pressure during the later part of life. Risk for diabetes was correlation to the intensity of the therapy and quantity of the shock waves administered; high blood pressure was correlation to therapy of stones in both kidneys.

Medicineworld.org: Shock Wave Therapy For Kidney Stones May Increase Risk Of Diabetes

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