Morphological Changes Induced in the Pig Kidney by Extracorporeal Shock Wave Lithotripsy: Nephron Injury

Youzhi Shao, Bret A. Connors, Andrew P. Evan, Lynn R. Willis, David A. Lifshitz, James E. Lingeman

Research output: Contribution to journalArticle

54 Scopus citations


While shock wave lithotripsy (SWL) is known to cause significant damage to the kidney, little is known about the initial injury to cells along the nephron. In this study, one kidney in each of six juvenile pigs (6-7 weeks old) was treated with 1,000 shock waves (at 24 kV) directed at a lower pole calyx with an unmodified HM-3 lithotripter. Three pigs were utilized as sham-controls. Kidneys were fixed by vascular perfusion immediately after SWL or sham-SWL. Three of the treated kidneys were used to quantitate lesion size. Cortical and medullary samples for light (LM) and transmission electron microscopy (TEM) were taken from the focal zone for the shock waves (F2), the contralateral kidney, and the kidneys of sham-SWL pigs. Because preservation of the tissue occurred within minutes of SWL, the initial injury caused by the shock waves could be separated from secondary changes. No tissue damage was observed in contralateral sham-SWL kidneys, but treated kidneys showed signs of injury, with a lesion of 0.2% ± 0.1% of renal volume. Intraparenchymal hemorrhage and injury to tubules was found at F2 in both the cortex and medulla of SWL-treated kidneys. Tubular injury was always associated with intraparenchymal bleeding, and the range of tissue injury included total destruction of tubules, focal cellular fragmentation, necrosis, cell vacuolization, and membrane blebbing. The initial injury caused by SWL was cellular fragmentation and necrosis. Cellular vacuolization, membrane blebbing, and disorganization of apical brush borders appear to be secondary changes related to hypoxia.

Original languageEnglish (US)
Pages (from-to)979-989
Number of pages11
JournalAnatomical Record - Part A Discoveries in Molecular, Cellular, and Evolutionary Biology
Issue number1
StatePublished - Nov 2003


  • Cell fragmentation
  • Extracorporeal shock wave lithotripsy
  • Lithotripsy injury
  • Nephron injury
  • Pig model
  • Renal morphology

ASJC Scopus subject areas

  • Agricultural and Biological Sciences (miscellaneous)
  • Anatomy

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