Kidney Stone Lithotripsy Linked to Diabetes

Shockwave therapy for renal stones increased the risk of diabetes by almost 400% and increased the risk of hypertension significantly compared with medical treatment, according to a new follow-up study.

In a chart review of 630 patients with renal and proximal ureteral calculi treated with shockwave lithotripsy at the Mayo Clinic (Rochester, MN, USA) in 1985, questionnaires were sent to 578 patients still alive in 2004. The 288 respondents were matched by age, gender, and year of presentation with a cohort of nephrolithiasis patients managed non-surgically.

Almost two decades later, analysis of the data found that lithotripsy increased the risk of developing diabetes 3.75 times that of patients treated medically. Development of diabetes was related to the number of shocks and total intensity of treatment. In the shock-wave group, 16.8% developed diabetes. The risk of developing hypertension, after excluding patients with pre-existing hypertension, was 1.47 times that of patients treated medically. The development of hypertension correlated strongly with bilateral treatments, but not with the total number of shocks, average intensity, or total intensity.

To our knowledge, this is the longest follow-up of patients treated with shockwave lithotripsy and the only study to demonstrate an association with diabetes, said Amy Kranbeck, M.D., and colleagues in an April 2006 online report by the Journal of Urology.

According to the researchers, diabetes in this group could be a result of damage to pancreatic islet cells, caused by microvascular damage to the pancreatic tissue and small hematomas after lithotriptor treatment. The researchers speculated that the hypertension risk might be related to parenchymal or vascular changes in the kidneys, with the risk exacerbated by bilateral treatments.



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