Strohmaier W L, Carl A M, Wilbert D M, Bichler K H
Department of Urology, Eberhard-Karls-University, Tuebingen, Germany.
J Urol. 1996 Jan;155(1):48-51.
There is ongoing controversy regarding blood pressure changes after extracorporeal shock wave lithotripsy (ESWL*). Experimental data suggest a role for renin but only few data are relevant to humans. It has been shown that renin secretion is stimulated by endothelin, a recently discovered peptide with strong vasoconstrictive properties and stimulating effects on renin secretion. Endothelin is relevant in the development of hypertension and acute renal failure.
In a prospective study of 48 normotensive patients undergoing ESWL for renal stones the influence of high energy shock waves on plasma endothelin and active renin was analyzed. These substances are secreted by renal cells in response to hemodynamic alterations, and inflammatory and traumatic processes. Peripheral blood samples were analyzed for active renin and endothelin before, and immediately, 1, 3 and 5 days after ESWL. Blood pressure was measured before, and 1, 3 and 5 days after ESWL.
Only a slight and transient increase was noted in active renin, which was in the same range as that found after mental stress. Endothelin and blood pressure were not significantly influenced by ESWL. There was no correlation between endothelin and active renin. Thus, the increase in active renin was not mediated by endothelin.
The transient increase in active renin cannot be attributed to the development of hypertension. The lack of influence of ESWL on endothelin indicates that ESWL, at least in the routine clinical setting, does not cause severe renal trauma.
关于体外冲击波碎石术（ESWL）后血压变化一直存在争议。实验数据表明肾素起了一定作用，但仅有少量数据与人类相关。研究表明，内皮素可刺激肾素分泌，内皮素是一种最近发现的具有强烈血管收缩特性且能刺激肾素分泌的肽。内皮素与高血压和急性肾衰竭的发生发展相关。
对48例接受ESWL治疗肾结石的血压正常患者进行前瞻性研究，分析高能冲击波对血浆内皮素和活性肾素的影响。这些物质由肾细胞分泌，以应对血流动力学改变、炎症和创伤过程。在ESWL治疗前、治疗后即刻、1天、3天和5天采集外周血样本，分析活性肾素和内皮素。在ESWL治疗前、治疗后1天、3天和5天测量血压。
仅观察到活性肾素轻微且短暂的升高，其升高幅度与精神应激后相当。ESWL对内皮素和血压无显著影响。内皮素与活性肾素之间无相关性。因此，活性肾素的升高并非由内皮素介导。
活性肾素的短暂升高不能归因于高血压的发生。ESWL对内皮素无影响表明，至少在常规临床情况下，ESWL不会导致严重的肾损伤。
