ABSENCE OF ACTIVATION OF PROTEOLYTIC-ENZYMES BY EXTRACORPOREAL SHOCK-WAVES

The mechanism of tissue damage by extracorporeal shock wave lithotrips y has not been clarified, but proteolytic enzymes are known to play an important role in tissue breakdown in response to other types of inju ry. Screening tests for activation of the proteolytic enzymes kallikre in, plasmin, trypsins 1 and 2, and granulocyte elastase therefore were performed for 4 to 5 hours in 14 dogs after unilateral treatment with 1500 or 2000 extracorporeal shock waves under anesthesia and vigorous hydration. We also studied the activity of the proenzymes prekallikre in, plasminogen, and prothrombin and three plasma protease inhibitors (kallikrein inhibitor, antiplasmin, and antithrombin III). Blood from both renal veins (treated and control kidneys) and the aorta and tissu e samples of the injured renal parenchyma and corresponding areas of t he control kidneys revealed no proteolytic enzyme activation by the sh ock waves and no decline in the activities of proenzymes and enzymes i nhibitors. Significant proteolysis does not seem to play a part in the tissue injury induced by extracorporeal shock wave lithotripsy.