The evaluation of effects of extracorporeal shock wave lithotripsy on kidney during different periods of urınary obstruction by using histopathologic examination and HSP-70 expression

VIII. SUMMARYAim: To evaluate the histopathological changes and expression of HSP-70 inrenal parencyhma exposed to ESWL in different periods of obstruction.Material and method: Twenty-eight rabbits (New Zelland type) were included inour study. Four and seven days obstruction models were formed in twenty-fiverabbits by laparatomy and binding the ureter during the operation. Another threerabbits constituted the sham group. Laparatomy and ureter dissection wasperformed in rabbits in the sham group. Then the operation was ended withoutbinding the ureter. After twenty-four hours, tissue samples were obtained. ESWLwith 1500 shock and 14 kV power was applied to Group-1 and Group-2 in thethird and the sixth days of hydronephrosis respectively. After twenty-four hours,tissue samples were examined histopathologically. Four and seven dayshydronephrosis were formed for Group1-control and Group 2-control in each fiverabbits respectively. The results of the groups exposed to ESWL in third and sixthdays of obstruction were compared with the the results of the control and shamgroups. Proximal tubules, peritubular fibrosis, mononuclear cell infiltration andglomerules were examined with the light microscope. In our study, we alsoexamined the positivity of HSP-70 in kidneys that forms as a response to ischemicinjury.Results: If we compare (Control-1-2) and (Group-1-2) with the sham group, theincrease in the renal size was detected in (Control-1-2) and (Group:1-2) and thatwas statistically significant (p< 0.0001). There was no difference between thecontrol and the study groups in case of fibrosis, congestion and mononuclear cellinfiltration (Fibrosis; Group-1 p=0.38, Group-2 p=0.29), (Congestion; Group-1p=0.19, Group-2 p=0.19), (Mononuclear cell infiltration; Group-1 p= 0.61,Group-2 p=0.13). There wasn?t any fibrosis, congestion or mononuclear cellinfiltration in the sham group. Light microscope did not show anyhistopathological changes in the glomerules. HSP-70 positivity was detected incortical collecting tubules in Group-1 and Group 1-control . The value of HSP-70positivity in cortical collecting tubules of Group-1 was higher than in Group-1control . The result was statistically significant (p=0.006). There was nostatistically significant difference between Group-2 and Group 2-control (p=0.62)in case of HSP-70 positivity in cortical collecting tubules. There was no HSP-70staining in any of the proximal tubule cells. The value of HSP-70 positivity inmedullary collecting tubules of Group-1 was higher than in Group 1-control thatwas statistically significant (p=0.033). The value of HSP-70 positivity inmedullary collecting tubules of Group-2 was lower than in Group 2-control thatwas statistically significant (p=0.042). HSP-70 positivity in medullary collectingtubules of the control and study groups was higher than the sham group and thatwas statistically significant (p=0.042). There was no statistically significantdifference between Group 1 compared to Group 1-control and Group-2 comparedto Group 2-control (p=0.57 and p=0.7, respectively) in case of HSP-70 positivityin the glomerules. Although there was different degrees of HSP-70 positivity ingroups, there was no glomerular staining of HSP-70 in sham group (p=0.001).Conclusion: There is no study about the harmful effects of ESWL in thepresence of hydronephrosis in the literature. In our study, we determined theharmful effects of ESWL in the presence of hydronephrosis in the proximaltubules, glomerules and cortical and medullary tubules. It was seem that if periodof obstruction increased, the harmful effects of ESWL on proximal tubulesincreased as well. To support these results, more studies are required in the future.