Are there long-term effects of extracorporeal shockwave lithotripsy in paediatric patients?

Authors


Sir,

The authors have described very well the long-term consequences of extracorporeal shockwave lithotripsy (ESWL) in children and concluded that there was no effect of ESWL on renal growth or development of hypertension or diabetes mellitus later in life [1].

Although, not USA Food and Drug Administration approved, ESWL is a commonly used treatment option for paediatric stone disease [2]. The long-term bio-effects of ESWL are still considered controversial, especially in the paediatric population.

Various studies have been conducted in this regard, but the dilemma persists as to whether ESWL given in the early decades of life is harmful as regards the later development of hypertension, diabetes mellitus or impact on renal growth. These issues are of concern as several animal studies have proved the potential for adverse long-term consequences of ESWL in the paediatric population in the form of a significant decrease in effective renal plasma flow or a significant increase in mean arterial blood pressure [3]. These animal studies suggest that the acute renal injury may progress to scar formation resulting in loss of functional renal volume. Also in a 9-year follow-up study of children, overall renal size was found to be decreased not only in the treated kidney after a session of ESWL, but also in the contralateral normal kidney [4].

There is ample published evidence that suggests the development of new onset of diastolic hypertension in adults long after lithotripsy and the paediatric kidney is more susceptible to injury as compared with adults [5].

Nevertheless, there is the utmost need for further research with longer follow-up durations on the mechanism and consequences of shockwave renal injury, especially in young populations.

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