Shock wave lithotripsy may increase risk of diabetes

Shock wave lithotripsy appears to significantly increase the risk for diabetes and hypertension later in life, according to Mayo Clinic researchers. Risk for diabetes was related to the intensity of the treatment and quantity of the shock waves administered, while hypertension was related to treatment of stones in both kidneys, as reported in the Journal of Urology (2006; 175:1742-7).

“This is a completely new finding,” said lead author Amy Krambeck, MD, who worked on the study with Joseph Segura, MD. “This opens the eyes of the world of urology to the fact that hypertension and diabetes are potential side effects. We can’t say with 100% certainty that the shock wave treatment for the kidney stones caused diabetes and hypertension, but the association was very strong.”

The chart review of 630 patients treated with shock wave lithotripsy in 1985 revealed that 19 years post-treatment, those treated had 3.75 times the risk of having diabetes and 1.47 times the risk of having hypertension. Diabetes seemed to be related to damage inflicted to the pancreas while hypertension seemed to be related to scarring, altering the secretion of hormones centered in the kidneys.

In related news, researchers at the University of Texas Southwestern Medical Center, Dallas, found that people with type 2 diabetes have highly acidic urine, a metabolic feature that may explain their greater risk for developing uric-acid kidney stones.

“Our next step is to find out what causes type 2 diabetics to have abnormally acidic urine, and what other urinary factors protect some diabetics who do not form uric-acid stones,” said lead author Mary Ann Cameron, MD.

When the team accounted for obesity and a diet rich in animal protein, type 2 diabetics continued to have more acidic urine levels when compared to nondiabetics, suggesting that other factors associated with this condition or insulin resistance account for the overly acidic urine in this population.

Findings were scheduled for publication in the May Journal of the American Society of Nephrology.