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Diabetes From Kidney Stone Blaster?

Nearly 4 Times Higher Diabetes Risk After Shock Wave Treatment for Kidney Stones
By
WebMD Health News
Reviewed by Louise Chang, MD

April 10, 2006 -- Pulverizing kidney stones with shock waves raises a person's risk of diabetes and high blood pressure, a new study shows.

In the early 1980s, getting a kidney stonekidney stone often meant painful open surgery. Then came shock wave lithotripsyshock wave lithotripsy. This revolutionary technology uses sonic waves to blast kidney stones into tiny grains of sand. No surgery is needed.

It's always seemed to be safe. But now there's disturbing new data from a Mayo Clinic study. The study appears in the May issue of the Journal of Urology.

Shock Wave Damage

The study compared kidney stone patients treated in 1985 with shock wave lithotripsy to patients given other nonsurgical kidney stone treatments that same year. Nineteen years later, the shock wave patients were nearly four times more likely to get diabetes. And, if both kidneys were treated, they were 47% more likely to have high blood pressure.

It's not yet clear how shock wave treatment might cause these problems, says researcher Amy E. Krambeck, MD. What seems to be happening is collateral damage from the shock waves.

"The theory is that the shear forces related to shock wave lithotripsy can cause tissue damage," Krambeck tells WebMD. "Damage to the pancreas could put patients at risk for diabetes."

Patients who got the most shock wave treatments -- at the highest intensity - had the highest risk of diabetes.

Don't Suspend Treatment

The shock wave machine used in 1985 is an older model. It's still in use at the Mayo Clinic, Krambeck says. Newer shock wave machines give a more focused shock -- but also provide stronger shock waves. Because the Mayo study is the first to link diabetes to shock wave treatment, it's not at all clear whether newer machines provide less risk, the same risk, or more risk.

Krambeck says much more study is needed. In the meantime, she says, there's no reason to stop using the machines for patients with large kidney stones.

There's no immediate danger for people who've had their kidney stones treated by shock wave, says Glenn Preminger, MD. Preminger chairs the American Urological Association's kidney stone treatment panel. He's professor of urologic surgery and director of the comprehensive kidney stone center at Duke University.

"Prudence -- and the need for surveillance -- is warranted," Preminger tells WebMD. "But we do not need to suspend shock wave lithotripsy or rush to the doctor at this point. Any stone-forming patients should have routine follow-up with their physicians. As part of that routine care, we would look for the possibility of high blood pressure and diabetes. So what I recommend is prudent follow-up care."

Treatment Options

There are different kinds of kidney stones -- and different treatment options.

"There are 101 ways to form a kidney stone," Krambeck says. "It all has to do with genetic makeup, diet, and lifestyle. Once a person forms a stone, he or she needs a complete metabolic evaluation to understand why. Then we can give medication to prevent a second stone."

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