PEDIATRIC KIDNEY - FUNCTIONAL OUTCOME AFTER EXTRACORPOREAL SHOCK-WAVELITHOTRIPSY

Purpose: We studied the efficacy, functional outcome and morphological changes following extracorporeal shock wave lithotripsy (ESWL) of re nal calculi in a pediatric population. Materials and Methods: We prosp ectively evaluated 50 patients 2 to 12 years old (mean age 7.64) under going ESWL with the Siemens Lithostar Plus. Functional outcome was ass essed by comparing total and ipsilateral glomerular filtration rates b efore and after ESWL, Glomerular filtration rate was measured using Ga tes' method on a (99m)technetium-pentetic acid radionuclide renal scan corrected to body surface area times 1.73 m.(2). Ultrasound was perfo rmed to assess morphological changes after ESWL. Results: The immediat e fragmentation rate was 86% and the clearance rate was 82%. At the en d of the study 40 patients were evaluable. Immediately after ESWL ultr asonography showed perirenal hematoma in 3 patients, intrarenal hemato ma in 2 and subcapsular hematoma in 1. These changes resolved spontane ously at followup, There was no change in total or ipsilateral glomeru lar filtration rate at a mean followup of 31.7 months. Before and afte r ESWL total glomerular filtration rates were 86.58 +/- 12.43 and 86.2 7 +/- 12.82 ml. per minute per 1.73 m(2), respectively. Treated kidney glomerular filtration rate decreased insignificantly from 40.58 m +/- 12.61 to 40.41 +/- 12.61 ml. per minute per 1.73 m(2), at 3 months. A t the last followup the change in glomerular filtration rate was insig nificant. Conclusions: ESWL is effective in the pediatric population, and it can be safely performed without long-term bio-effects on the fu nction or morphology of the growing kidney.