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The margin of safety for the kidney during SW application is as of yet largely unknown [13]. The appearance of detrimental effects after intense ESWL applications has been confirmed in many studies [13, 14]. In animal models, no pathological changes were observed after application of 500 SWs. However, the pathological changes began to appear at higher doses, and 8000 SWs were reported to be lethal for a rabbit in the Guneasekaran study [12, 15]. In addition, animal studies have demonstrated Unoprostone that acute changes following ESWL are similar to those seen in human subjects [15, 16]. Moreover, the chronic renal changes noted in animal studies include diffuse interstitial fibrosis, loss of nephrons, focal calcification, and perinephric scarring [17]. In our histomorphological evaluations, subcapsular hemorrhage, tubuloepithelial vacuolization, tubular atrophy, glomerular destruction and ureteral fibrosis were detected at low levels in every group. Intraparenchymal hemorrhage and perivascular fibrosis were also mild. There was no statistical difference between the groups in terms of histomorphological parameters, except for perivascular BGJ398 supplier fibrosis. Although, there was a significant difference for perivascular fibrosis between the 3rd and 4th group (p selleck compound library Furthermore, evidence of permanent changes (e.g., fibrosis, tubular and glomerular damage, chronic inflammatory alterations) was also observed in our study, which is in accordance with other studies [13, 14]. Therefore, we recommend that in such studies, additional histomorphological evaluation should be performed at the 3rd month post-therapy in order to determine whether such chronic changes are permanent. Early experimental animal studies using ESWL were performed with a dog model, but subclinical levels of SW treatments were used. Only 500 SWs were given to each kidney and none of these kidneys demonstrated any pathological changes [12].