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The present study was designed to determine the effects  of shock wave voltage (kV) on lesion size and renal function induced by shock  wave lithotripsy (SWL) in the 6- to 8-wk-old pig. Each SWL-treated pig  received 2000 shock waves at 12, 18, or 24 kV to the lower pole calyx of one  kidney. A group of sham SWL pigs served as time controls. Bilateral GFR, renal  plasma flow (RPF), and para-aminohippurate (PAH) extraction were measured 1 h  before and 1 and 4 h after SWL in all treated and sham animals. The kidneys  were removed at the end of each experiment for morphometric analysis. The  SWL-induced lesion increased significantly in size as shock wave energy was  increased from 12 to 24 kV. PAH extraction, a measure of tubular function, was  not significantly affected at 12 kV, was transiently reduced at 18 kV, and was  reduced for the duration of the experiment at 24 kV. GFR and RPF, however,  were significantly and similarly reduced at the 1 h post-SWL period at all  three kilovolt levels. At the 4-h post-SWL period, both GFR and RPF had  returned to baseline levels. Lesion size and tubular injury were correlated  with changes in kilovoltage, while changes in renal hemodynamics were already  maximal at the lowest discharge voltage. These findings suggest that renal  microvessels are highly sensitive to shock waves and that frank injury to  tubules and vessels may be more closely related to discharge energy than is  renal blood flow.

The Effect of Discharge Voltage on Renal Injury and Impairment Caused by Lithotripsy in the Pig