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      Renal Nerves Mediate Changes in Contralateral Renal Blood Flow after Extracorporeal Shockwave Lithotripsy

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          Renal blood flow falls in both kidneys following delivery of a clinical dose of shockwaves (SW) (2000 SW, 24 kV, Dornier HM3) to only one kidney. The role of renal nerves in this response was examined in a porcine model of renal denervation. Six-week-old pigs underwent unilateral renal denervation. Nerves along the renal artery of one kidney were identified, sectioned and painted with 10% phenol. Two weeks later the pigs were anesthetized and baseline renal function was determined using inulin and PAH clearances. Animals then had either sham-shockwave lithotripsy (SWL) (group 1), SWL to the innervated kidney (group 2) or SWL to the denervated kidney (group 3). Bilateral renal function was again measured 1 and 4 h after SWL. Both kidneys were then removed for analysis of norepinephrine content to validate the denervation. Renal plasma (RPF) flow was significantly reduced in shocked innervated kidneys (group 2) and shocked denervated kidneys (group 3). RPF was not reduced in the unshocked denervated kidneys of group 2. These observations suggest that renal nerves play a pivotal role in modulating the vascular response of the contralateral unshocked kidney to SWL, but only a partial role, if any, in modulating that response in the shocked kidney.

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          Most cited references 6

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          The Effects of Mechanical Stimulation on Some Electrical Properties of Axons

          Rapid, short duration mechanical compression of lobster giant axons by a crystal-driven stylus produces a depolarization and an increase in membrane conductance which develop immediately with compression but take several seconds to recover. The conductance increase occurs even when the depolarization is prevented electrically. If sodium is removed from the external medium or if procaine is added to it, compression produces almost no depolarization. Small bundles of myelinated frog fibers are depolarized by rapid compression but recover very rapidly (milliseconds); "off" responses are occasionally seen. The results are discussed in terms of the mechanoelectric transducer behavior of an axon membrane.
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            Renorenal reflexes in the rat elicited upon stimulation of renal chemoreceptors.

            The effects of renal ischemia and backflow of non-diuretic urine into the renal pelvis on renal efferent sympathetic postganglionic nerve activity, femoral arterial pressure and heart rate were studied to verify whether stimulation of renal chemoreceptors elicits autonomic reflexes. In rats with intact spinal cord or spinal cord sectioned at the T6 level a brief activation of renal chemoreceptors produced excitatory ipsilateral and contralateral renorenal reflexes, whereas it only slightly and insignificantly altered arterial pressure and heart rate. These results indicate that stimulation of renal chemoreceptors elicits renorenal excitatory reflexes which might be integrated both at spinal and supraspinal levels.
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              Effects of extracorporeal shock wave lithotripsy to one kidney on bilateral glomerular filtration rate and PAH clearance in minipigs.

               L Willis,  A Evan,  B Connors (1996)
              This study examined the acute time course of effects of extracorporeal shock wave lithotripsy (ESWL) on renal hemodynamics in anesthetized minipigs with and without pretreatment with verapamil. We applied ESWL (2000 shocks, 24 kV, unmodified Dornier HM3), to the right kidneys of isoflurane-anesthetized female pigs. Urine flow and renal hemodynamics were monitored from each kidney via ureteral balloon catheters. Arterial blood pressure and bilateral urine flow, glomerular filtration rate (GFR, insulin clearance) and renal plasma flow (RPF, para-aminohippurate clearance) were monitored for 45 minutes before ESWL, and at 1, 4 and 24 hours after ESWL. Treatment with ESWL consistently caused unilateral hematuria and subcapsular renal hematomas in the shocked kidneys and significantly reduced GFR and RPF in those kidneys at 1 and 4 hours after ESWL. Urine flow was reduced through 24 hours in the shocked kidneys. Renal plasma flow, but not GFR, was significantly reduced in the contralateral (unshocked) kidneys at 1 and 4 hours after ESWL to the other kidneys. Verapamil blunted the ESWL-induced reductions of urine flow, GFR and RPF in the shocked kidneys and eliminated the reduction of RPF in the unshocked kidneys. These experiments demonstrate that ESWL to 1 kidney acutely impaired hemodynamics in both kidneys and that verapamil attenuated the response in the shocked kidneys and eliminated it in the contralateral unshocked kidneys.

                Author and article information

                Nephron Physiol
                Nephron Physiology
                S. Karger AG
                December 2003
                30 December 2003
                : 95
                : 4
                : p67-p75
                Departments of aAnatomy and Cell Biology, bPharmacology and Toxicology, and cPsychiatry, dMedicine, Indiana University School of Medicine, Indianapolis, Ind.; eDepartment of Surgery, Urology Section, University of Chicago, Chicago, Ill., and fMethodist Hospital Institute for Kidney Stone Disease, Indianapolis, Ind., USA; gDepartment of Urology, Rabin Medical Center, Petach Tikvah, Israel
                74843 Nephron Physiol 2003;95:p67–p75
                © 2003 S. Karger AG, Basel

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                Page count
                Figures: 6, Tables: 2, References: 28, Pages: 1
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