Contrast media- (CM-) induced nephropathy is a serious complication of radiodiagnostic procedures. Available data suggests that the development of prophylaxis strategies is limited by poor understanding of pathophysiology of CM-induced nephropathy. Present study was designed to determine the role of oxidative stress, myeloperoxidase, and nitric oxide in the pathogenesis of iohexol model of nephropathy and its modification with simvastatin (SSTN). Adult Sprague Dawley rats were divided into seven groups. After 24 h of water deprivation, all the rats except in control and SSTN-only groups were injected (10 ml/kg) with 25% glycerol. After 30 min, SSTN (15, 30, and 60 mg/kg) was administered orally, daily for 4 days. Twenty-four hours after the glycerol injection, iohexol was infused (8 ml/kg) through femoral vein over a period of 2 min. All the animals were sacrificed on day 5 and blood and kidneys were collected for biochemical and histological studies. The results showed that SSTN dose dependently attenuated CM-induced rise of creatinine, urea, and structural abnormalities suggesting its nephroprotective effect. A significant increase in oxidative stress (increased lipid hydroperoxides and reduced glutathione levels) and myeloperoxidase (MPO) and decreased nitric oxide in CM group were reversed by SSTN. These findings support the use of SSTN to combat CM-induced nephrotoxicity.
Over a ten year period (1979 to 1989), 200 patients have undergone live donor nephrectomy through a flank extraperitoneal approach without rib resection. The average hospital stay was short and the major complications were negligible. Early graft function was seen in 97% of the cases. Delayed function due to acute tubular necrosis developed in 3%. Urinary leak was seen in 3%. Two kidneys were lost due to infection related to urinary fistulae. In 70 donors, 37 ± 23 months' follow-up was available. Hypertension developed in two patients three and three and one-half years post donation. Significant proteinuria (>300 mg/day) was noted in one patient. No significant renal functional abnormalities were observed. Creatinine clearance was about 70% of the initial measurement at the observation time. We conclude that extraperitoneal flank live donor nephrectomy is generally safe and associated with minimal perioperative and long-term morbidity. Moreover, the procedure provides an excellent allograft function. Ann Saudi Med 1993;13 (5) The use of live related donors for kidney transplantation offers superior results. Shortage of suitable cadaveric kidneys argues in favor of such procedure [1,2]. The possible occurrence of complications to the donor weighs against taking kidneys from normal individuals. The justification for using healthy donors is that there is a negligible morbidity. Experimental evidence in rats, however, shows that extreme renal ablation as in unilateral nephrectomy can induce a state of hyperfiltration that results in glomerulosclerosis, proteinuria, hypertension and progressive renal failure [3][4][5]. On the other hand, studies on the follow-up of living kidney donors indicated no significant deterioration in renal function [6][7][8][9][10][11].The high incidence of hypertension after unilateral nephrectomy has been reported in some studies [7,8,10] but not in others [9,11]. Kidney donation may predispose patients to late development of proteinuria [6][7][8].Because there has always been a question on the safety of the procedure and the long-term effects on the health of the kidney donors, we retrospectively evaluated the experience of Riyadh Armed Forces Hospital with livingrelated donors in renal transplantation. Material and Methods Evaluation of the live kidney donorsKidney donors were first degree relatives of patients with renal failure to whom they donated a kidney. Workup was done on the basis of immunologic screening, thorough evaluation of general health and renal function. Renal anatomy was evaluated with excretory urography and angiography. Each patient had initial 24-hour creatinine clearance measurement. Preference was given to the left kidney unless multiple arteries were present. Technique of nephrectomyAdequate intravenous hydration was begun the evening before surgery to minimize the ischemic renal damage. Nephrectomy was performed through the standard flank retroperitoneal approach in the 11th intercostal space. Pleural or peritoneal injuries were identified and closed. The ureter...
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