Acute Effects of Percutaneous Tract Dilation on Renal Function and Structure

Handa, Rajash K.; Matlaga, Brian R.; Connors, Bret A.; Ying, Jun; Paterson, Ryan F.; Kuo, Ramsay L.; Kim, Samuel; Lingeman, James E.; Evan, Andrew P.; Willis, Lynn R.

doi:10.1089/end.2006.20.1030

Cited by 54 publications

(74 citation statements)

References 24 publications

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“…In fact, the stimulus to increase PRA may be multifactorial and include tissue injury-related factors (e.g., oxidative stress 16 ) and/or increased renal nerve activity-the sympathetic nervous system having direct and indirect actions on the kidney to increase renin release. 17 We have consistently shown that the EPAH is decreased after PERC procedures 2,9 (present study) and can last at least 3 days postsurgery. 10 PAH is transported from the blood into the renal tubules through selective organic anion transporters (OATs) located on proximal tubule membranes.…”

supporting

confidence: 62%

“…This is in agreement with our previous animal work, in which we demonstrated that single-tract PERC or multiple-tract PERC to a single kidney results in bilateral renal vasoconstriction. 2,12 Such bilateral renal effects have also been reported in patients undergoing unilateral PCNL. 3,6 The mechanism(s) involved in initiating vasoconstriction in the treated and nontreated kidney and the method of communication between both kidneys are unknown, but could involve the sympathetic nervous system (i.e., reno-renal reflexes) and/or humoral systems.…”

mentioning

confidence: 77%

“…In this regard, we have previously reported much greater declines in GFR and renal perfusion after a conventional PERC surgical procedure that involved an average of three needle sticks to access the pig's renal collecting system. 2 However, a controlled study examining single-vs multiple-needle-stick puncture of the kidney would be needed to validate this suspicion. Our finding would also suggest that dilating the needle access site up to 30F has similar adverse effects on renal hemodynamics as needlestick access alone.…”

Section: Discussionmentioning

confidence: 99%

“…The methods of anesthesia, general surgery, percutaneous access of the renal collecting system, and renal function measurements have been extensively described in a previous publication. 2 In brief, anesthesia was induced and maintained with ketamine/ xylazine plus isoflurane. Catheters were inserted into the ear vein for infusion of fluids, inulin, and para-amino hippurate (PAH); femoral artery for blood pressure monitoring; renal veins to collect samples for the plasma renin activity (PRA) and to measure the renal extraction of PAH (EPAH); and ureters for retrograde injection of X-ray contrast agent to define renal collecting system and collection of urine.…”

Section: Methodsmentioning

confidence: 99%

“…PCNL is associated with high stone-free rates, low retreatment rates, and a low incidence of complications. 1 However, localized injury and acute ischemia to kidney tissue are features of the PCNL access procedure, 2 and perhaps not surprisingly, studies in patients and experimental animals have shown that PCNL can acutely impair glomerular filtration and renal perfusion. [2][3][4][5][6] The initial decline in renal hemodynamics after PCNL has a rapid onset and is not restricted to the PCNL-treated kidney, being present also in the contralateral nontreated kidney.…”

mentioning

confidence: 99%

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Percutaneous Renal Access: Surgical Factors Involved in the Acute Reduction of Renal Function

Handa

Johnson

Connors

et al. 2016

Journal of Endourology

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Introduction and Objective: Studies in patients and experimental animals have shown that percutaneous nephrolithotomy (PCNL) can acutely impair glomerular filtration and renal perfusion, but the factors contributing to this decline in renal function are unknown. The present study assessed the contribution of needle puncture of the kidney vs dilation of the needle tract to the acute decline in renal hemodynamic and tubular transport function associated with PCNL surgery. Materials and Methods: Acute experiments were performed in three groups of anesthetized adult farm pigs: sham-percutaneous access (PERC), that is, no surgical procedure (n = 7); a single-needle stick to access the renal collecting system (n = 8); expansion of the single-needle access tract with a 30F NephroMax balloon dilator and insertion of a nephrostomy sheath (n = 10). The glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and renal extraction of para-amino hippurate (EPAH, estimates tubular organic anion transporter [OAT] activity) were assessed before and 1 to 4.5 hours after sham-PERC or PERC surgical procedures. Results: Overall, GFR responses were similar in all three groups. Sham-treated PERC pigs showed no significant change in ERPF over the experimental observation period, whereas a single-needle stick to access the renal collecting system resulted in renal vasoconstriction (*30% reduction in ERPF, p < 0.05). Dilation of the single-needle access tract to create the nephrostomy did not lead to a further decline in ERPF. PERC surgical procedure-mediated renal vasoconstriction was most evident at the 1-hour posttreatment time point. A reduction in EPAH was only observed in pig kidneys with a nephrostomy. Conclusions: Needle puncture of the kidney for percutaneous access to the renal collecting system is the major driving force for the renal vasoconstriction observed after PCNL surgery, whereas creation of the nephrostomy appears to be largely responsible for decreasing tubular OAT activity.

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supporting

confidence: 62%

mentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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