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Renal complications of extracorporeal shock wave lithotripsy

Gary C Curhan, MD, ScD
Glenn M Preminger, MD
Eric N Taylor, MD, MSc
Section Editor
Stanley Goldfarb, MD
Deputy Editor
Albert Q Lam, MD


Extracorporeal shock wave lithotripsy (ESWL) is widely used in the treatment of symptomatic renal and ureteral stones [1,2], but it is not indicated for asymptomatic small stones. It is most effective for stones in the renal pelvis and upper ureter, and it is less effective for larger stones (>1.5 cm), stones of harder composition (cystine, calcium oxalate monohydrate), and stones in complex renal or ureteral locations (lower pole calyx or middle or lower ureter) [3].

Although ESWL is highly effective, a number of urinary tract complications can occur [2]. The renal complications of ESWL will be reviewed here. The role of ESWL and other modalities in the treatment of nephrolithiasis are discussed separately. (See "Options in the management of renal and ureteral stones in adults", section on 'Shock wave lithotripsy' and "Management of ureteral calculi", section on 'Shock wave lithotripsy'.)


There are four potential renal and urinary tract complications of extracorporeal shock wave lithotripsy (ESWL):

Incomplete stone fragmentation, which can lead to urinary tract obstruction

Renal parenchymal injury


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Literature review current through: Sep 2016. | This topic last updated: Jul 6, 2015.
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  1. Segura JW. Surgical management of urinary calculi. Semin Nephrol 1990; 10:53.
  2. Smith LH, Drach G, Hall P, et al. National High Blood Pressure Education Program (NHBPEP) review paper on complications of shock wave lithotripsy for urinary calculi. Am J Med 1991; 91:635.
  3. Ehreth JT, Drach GW, Arnett ML, et al. Extracorporeal shock wave lithotripsy: multicenter study of kidney and upper ureter versus middle and lower ureter treatments. J Urol 1994; 152:1379.
  4. Evan AP, Willis LR, Connors B, et al. Shock wave lithotripsy-induced renal injury. Am J Kidney Dis 1991; 17:445.
  5. Stoller ML, Litt L, Salazar RG. Severe hemorrhage after extracorporeal shock-wave lithotripsy. Ann Intern Med 1989; 111:612.
  6. Willis LR, Evan AP, Connors BA, et al. Relationship between kidney size, renal injury, and renal impairment induced by shock wave lithotripsy. J Am Soc Nephrol 1999; 10:1753.
  7. Dhar NB, Thornton J, Karafa MT, Streem SB. A multivariate analysis of risk factors associated with subcapsular hematoma formation following electromagnetic shock wave lithotripsy. J Urol 2004; 172:2271.
  8. Jang YB, Kang KP, Lee S, et al. Treatment of subcapsular haematoma, a complication of extracorporeal shock wave lithotripsy (ESWL), by percutaneous drainage. Nephrol Dial Transplant 2006; 21:1117.
  9. Kim TB, Park HK, Lee KY, et al. Life-threatening complication after extracorporeal shock wave lithotripsy for a renal stone: a hepatic subcapsular hematoma. Korean J Urol 2010; 51:212.
  10. Strohmaier WL, Bichler KH, Koch J, et al. Protective effect of verapamil on shock wave induced renal tubular dysfunction. J Urol 1993; 150:27.
  11. Parks JH, Worcester EM, Coe FL, et al. Clinical implications of abundant calcium phosphate in routinely analyzed kidney stones. Kidney Int 2004; 66:777.
  12. Xenocostas A, Jothy S, Collins B, et al. Anti-glomerular basement membrane glomerulonephritis after extracorporeal shock wave lithotripsy. Am J Kidney Dis 1999; 33:128.
  13. Williams CM, Thomas WC Jr. Permanently decreased renal blood flow and hypertension after lithotripsy. N Engl J Med 1989; 321:1269.
  14. Sheir KZ, Gad HM. Prospective study of the effects of shock wave lithotripsy on renal function: role of post-shock wave lithotripsy obstruction. Urology 2003; 61:1102.
  15. Fayad A, El-Sheikh MG, Abdelmohsen M, Abdelraouf H. Evaluation of renal function in children undergoing extracorporeal shock wave lithotripsy. J Urol 2010; 184:1111.
  16. El-Nahas AR, Awad BA, El-Assmy AM, et al. Are there long-term effects of extracorporeal shockwave lithotripsy in paediatric patients? BJU Int 2013; 111:666.
  17. Liou LS, Streem SB. Long-term renal functional effects of shock wave lithotripsy, percutaneous nephrolithotomy and combination therapy: a comparative study of patients with solitary kidney. J Urol 2001; 166:36; discussion 36.
  18. Ackaert KS, Schröder FH. Effects of extracorporeal shock wave lithotripsy (ESWL) on renal tissue. A review. Urol Res 1989; 17:3.
  19. Krambeck AE, Gettman MT, Rohlinger AL, et al. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup. J Urol 2006; 175:1742.
  20. Janetschek G, Frauscher F, Knapp R, et al. New onset hypertension after extracorporeal shock wave lithotripsy: age related incidence and prediction by intrarenal resistive index. J Urol 1997; 158:346.
  21. Williams CM, Thomas WC Jr, Bucci CM, Wilcox CS. Low-renin hypertension after extracorporeal shock wave lithotripsy. JAMA 1989; 262:1952.
  22. Krambeck AE, Rule AD, Li X, et al. Shock wave lithotripsy is not predictive of hypertension among community stone formers at long-term followup. J Urol 2011; 185:164.
  23. Lingeman JE, Woods JR, Toth PD. Blood pressure changes following extracorporeal shock wave lithotripsy and other forms of treatment for nephrolithiasis. JAMA 1990; 263:1789.