A new study from the University of Washington found an innovative technique called burst wave lithotripsy (BWL) may provide an effective, more accessible treatment for kidney stones.
The team says using focused ultrasound bursts to break up kidney stones, BWL provides a promising new approach to avoiding the high costs and healthcare burden of kidney stone treatment.
The study is published in the Journal of Urology and was conducted by Jonathan Harper et al.
Kidney stones are a very common condition, affecting 1 in 10 Americans at a cost of $10 billion per year. While many stones pass on their own, other treatments are sometimes needed.
Some fairly small stones can be treated using a technique called extracorporeal shock wave lithotripsy (ESWL), using shock waves to break up the stones so that they will be more likely to pass on their own.
The ESWL procedure is performed in a hospital or clinic, typically with the patient under sedation.
In contrast to the shock waves used in ESWL, the BWL procedure uses “short harmonic bursts” of ultrasound energy—potentially allowing the stones to be broken up in a shorter procedure without the need for sedation or anesthesia.
Pre-clinical studies supported the effectiveness of BWL in breaking up experimental stones of varying size and composition.
For the next step in developing the procedure, the team performed initial studies in human patients with kidney stones.
The patients were undergoing a surgical procedure, called ureteroscopy, that is used to treat larger stones. Before that treatment, the stones were treated with a short period of BWL—no longer than 10 minutes.
Using the ureteroscope, the researchers were able to directly observe how well the ultrasound waves worked in breaking up stones, as well as observing any injury to the kidney tissues.
In the study, BWL was used in 19 patients to target 25 confirmed stones. Overall, a median of 90% of the stone volume was completely broken up (comminuted) within the brief treatment period.
Thirty-nine percent of stones were completely fragmented while 52% were partially fragmented.
Most of the stone fragments measured less than two millimeters—small enough that they would be easily able to pass on their own, without much pain.
Examination through the ureteroscope showed mild or no tissue injury related to the BWL procedure, consisting mainly of mild bleeding.
The team says for several reasons, BWL could be an important practical advance in the management of kidney stones.
Many patients make multiple visits to the emergency department while waiting for definitive treatment of their kidney stones, often requiring opioids for pain management. Some patients require repeated treatment, even after surgery or ESWL.
The ability to noninvasively break stones and expel the fragments in awake patients at first presentation in the ED or clinic has the potential to provide just-in-time treatment leading to a reduction of the overall pain, cost and resource burden associated with a stone event.
Previous research has found that some common drugs may increase kidney disease risk.
In a recent study from the University of California San Diego and published in Scientific Reports, researchers found that patients who took PPIs were more likely to experience kidney disease.
Proton pump inhibitors (PPIs), which include well-known brand names Prilosec, Nexium, and Prevacid, are among the most commonly prescribed medications in the world.
Approximately 10% of adults in the United States take these drugs for frequent heartburn, acid reflux, and gastroesophageal reflux disease.
In the study, the team analyzed the FAERS database contains more than 10 million patient records — all voluntary reports of adverse effects while taking a medication.
The research team focused on patients who took PPIs and no other medications, narrowing their study population down to approximately 43,000 patients.
They also included the control group, approximately 8,000 patients who took histamine-2 receptor blockers, such as Zantac or Pepcid, and no other medications.
The team found patients who took only PPIs reported a kidney-related adverse reaction at a frequency of 5.6%, compared to just 0.7% for patients who took only histamine-2 receptor antagonists.
Compared to the control group, patients who took only PPIs were 28.4 times more likely to report chronic kidney disease, as well as acute kidney injury (4.2 times more likely), end-stage renal disease (35.5 times more likely), and unspecified kidney impairment (8 times more likely).
Patients who took PPIs were also more likely to experience electrolyte abnormalities, but this varied more by individual PPI, while the kidney-specific effects held true for all five PPIs examined.
As the World Health Organization notes, PPIs are essential medicines for many people, helping them to control symptoms that are often painful and disruptive to daily life.
But the team hopes this initial data will prompt health care providers to provide the appropriate warnings, education, and monitoring for patients who require PPIs, particularly if they are already at elevated risk for kidney disease.
If you care about kidney health, please read studies about common painkillers that may harm your heart and kidneys, and findings of how to protect against kidney disease.
For more information about kidney health, please see recent studies about why processed foods trigger chronic kidney disease and results showing that this diabetes drug may help slow down chronic kidney disease.
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