HISTOMORPHOLOGIC AND ULTRASTRUCTURAL FINDINGS OF SHOCKWAVE-INDUCED LESIONS IN THE ISOLATED-PERFUSED KIDNEY OF THE PIG

The aim of this investigation was the development of an easily reprodu cible model with which to evaluate shockwave-induced renal tissue dama ge using light and electron microscopy. Kidneys (n = 45) from freshly slaughtered pigs were perfused under physiologic conditions and treate d with shockwaves at different doses (2-250 shockwaves; 12-20 kV) on t he Modulith SL 20 lithotripter. The dose-dependent alterations in tiss ue structure were characterized by disintegration of tubular cells lea ding to circumscribed gap-like defects resulting from reticular fiber disruptions. Even after low shockwave doses, cellular and subcellular alterations could be observed. Our findings in this ex vivo model veri fy the development of considerable strictly localized, dose-dependent shockwave-induced damage of the renal parenchyma. On morphologic groun ds, we cannot confirm a primary lesion or rupture of blood vessel wall s as the cause of the shockwave lesions. The destruction of tubular ce lls in combination with disruption of peritubular and pericapillary re ticular fiber coats results in capillarotubular leaks, which can expla in even severe transitory macrohematuria after clinical shockwave lith otripsy without renal hematoma formation.