Focused Ultrasound Therapy
Focused ultrasound is a rapidly evolving, noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with acute tubular necrosis (ATN). This novel technology focuses beams of ultrasound energy precisely and accurately on targets in the body without damaging surrounding normal tissue.
How it Works
Where the beams converge, focused ultrasound produces two therapeutic effects that are being evaluated. The first mechanism is the application of energy on the renal artery, which causes a temporary vasodilation as the endothelial layer releases nitric oxide. The second mechanism is that the treatment of the renal artery also causes a temporary enhancement of the permeability of the downstream glomerulus. Both of these changes improve the ability of the kidney to handle the cause of the tubular necrosis in preclinical models. Further research is needed to determine whether these effects will translate to the clinical arena.
The primary options for treatment of acute tubular necrosis include medication and sometimes dialysis or invasive surgery.
For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications – such as surgical wound healing or infection – at a lower cost. It can reach the desired target without damaging surrounding tissue and is repeatable, if necessary.
At the present time, there are no clinical trials recruiting patients for focused ultrasound treatment of acute tubular necrosis.
Regulatory Approval and Reimbursement
Focused ultrasound treatment for acute tubular necrosis is not yet approved by regulatory bodies or covered by medical insurance companies.
Yang FY, Chiu WH. Focused ultrasound-modulated glomerular ultrafiltration assessed by functional changes in renal arteries. PLoS One. 2013.
Fischer K, McDannold NJ, Zhang Y, Kardos M, Szabo A, Szabo A, Reusz GS, Jolesz FA. Renal ultrafiltration changes induced by focused US. Radiology. 2009
F.-Y. Yang, W.-H. Chiu, S.-H. Liu, G.-L. Lin, and F.-M. Ho, Functional changes in arteries induced by pulsed high-intensity focused ultrasound. IEEE Trans. Ultrason. Ferroelectr. Freq. Control., vol. 56, no. 12, pp. 2643–2649, Dec. 2009.
A. Maruo, C. E. Hamner, A. J. Rodrigues, T. Higami, J. F. Greenleaf, and H. V. Schaff, Nitric oxide and prostacyclin in ultrasonic vasodilatation of the canine internal mammary artery. Ann. Thorac. Surg., vol. 77, no. 1, pp. 126–132, Jan. 2004.
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