Clamping renal artery alone produces less ischemic damage compared to clamping renal artery and vein together in two animal models: near-infrared tissue oximetry and quantitation of 8-isoprostane levels

Colli, Janet; Wang, Z.; Johnsen, Niels V.; Grossman, Leah; Lee, B. R.

doi:10.1007/s11255-012-0297-7

Cited by 12 publications

(16 citation statements)

References 22 publications

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“…All of the above-mentioned histological damage was observed in three ischaemic groups of the present study but with different intensities: BIR-V group >> BIR-P group > BIR-A group. Due to increased use of laparoscopic partial nephrectomy for renal tumour resection, during which temporary renal blood flow stoppage is required, several studies have compared kidney damage induced by occluding pedicle with renal artery only via laparoscopy versus open surgery in humans (Gong et al, 2008;Liu et al, 2013) and large animals (Colli, Wang, Johnsen, Grossman, & Lee, 2013;Orvieto et al, 2007;Schuler et al, 2008;Tracy et al, 2010). It was suggested that probably negated the benefit of renal artery clamping (Orvieto et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

“…n = 7 in each group. Due to increased use of laparoscopic partial nephrectomy for renal tumour resection, during which temporary renal blood flow stoppage is required, several studies have compared kidney damage induced by occluding pedicle with renal artery only via laparoscopy versus open surgery in humans(Gong et al, 2008;Liu et al, 2013) and large animals(Colli, Wang, Johnsen, Grossman, & Lee, 2013;Orvieto et al, 2007;Schuler et al, 2008;Tracy et al, 2010). ↔, Bowman's space; *, intratubular proteinaceous cast; ×, vascular or haemorrhagic congestion; C, collecting duct; D, distal tubule; G, glomerulus; P, proximal tubule; T, thick ascending limb detachment of viable cells.…”

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confidence: 99%

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Comparison of ischaemia–reperfusion‐induced acute kidney injury by clamping renal arteries, veins or pedicles in anaesthetized rats

Owji

Nikeghbal

Moosavi

2018

Experimental Physiology

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Animal models of ischaemic acute kidney injury (AKI) are valuable tools, but their therapeutic outcomes are not usually translated to humans. Ischaemic AKI in murines is mostly induced via renal pedicle clamping, which is different from patients with AKI that is due to renal artery hypoperfusion or vein thrombosis. This study was designed to compare the traditional pedicle-clamping with artery or vein occlusion alone in rat models of bilateral renal ischaemia-reperfusion (BIR). Twenty-eight anaesthetized male Sprague-Dawley rats were divided into four groups, a sham-operation group and groups that underwent 2 h reperfusion following 30 min clamping of renal arteries (BIR-A group), veins (BIR-V group) or pedicles (BIR-P group). The levels of epithelial injury in proximal tubules and thick ascending limb, intratubular casts and vascular congestion as well as renal malondialdehyde were moderately lower in the BIR-A than BIR-P group, while the BIR-V group showed much higher degrees of these damages than both these groups along with massive haemorrhagic congestion. Accordingly, renal blood flow, glomerular filtration, Na reabsorption, K and urea excretion, free water reabsorption and urine osmolality were lower in the BIR-V group than in the BIR-A and BIR-P groups, while the BIR-P group had slightly worse renal functional disorders than the BIR-A group. It seems that transmission of high arterial pressure into renal microvessels during venous occlusion causes rupture of capillary walls and haemorrhagic congestion, which leads to intensive kidney injury. In conclusion, the differences in renal disturbances induced by artery, vein and pedicle clamping strongly suggest use of a proper experimental model for each type of human ischaemic AKI.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison of ischaemia–reperfusion‐induced acute kidney injury by clamping renal arteries, veins or pedicles in anaesthetized rats

Owji

Nikeghbal

Moosavi

2018

Experimental Physiology

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“…Renal ischemic time should be less than 20 minutes, otherwise renal injury may be caused [3]. A study in swines showed that clamping renal artery alone results in less ischemic damage of the organ [2], however, dissection to separate the renal artery and vein is necessary [3], increasing surgical time.…”

Section: Discussionmentioning

confidence: 99%

“…Urine culture was positive for coagulase-negative Staphylococcus sp., susceptible to multiple classes of antibiotics. The patient remained hospitalized receiving fluid therapy with lactated Ringer's solution 1 (40 mL/kg/day IV), omeprazole 2 (1 mg/kg q 24h IV), maropitant 3 (1 mg/kg q 24h SC) and tramadol 4 (3 mg/kg q 8h SC). Enrofloxacin 5 (5 mg/kg q 24h IV) was prescribed based on urine culture and sensitivity testing.…”

Section: Casementioning

confidence: 99%

Treatment of an Atypical Case of Bilateral Nephrolithiasis in a Canine

Rovaris

Gouvêa

Tisotti

et al. 2020

Acta Scientiae. Vet.

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Background: Less than 5% of canine uroliths are found in the kidney and ureter. The decision to remove a nephrolith is controversial and should be considered in cases of refractory infection, hematuria, presence of obstructive uropathy and compression of the renal parenchyma. The aim of this report is to describe an unusual presentation of bilateral nephrolithiasis in a dog, occupying almost the entire renal parenchyma, its clinical and imaging findings, in addition to surgical treatment and its evolution.Case: A 10-year-old male Basset Hound was evaluated at the Veterinary Medical Teaching Hospital (HCV) of the Federal University of Rio Grande do Sul (UFRGS), presenting prostration, anorexia, vomiting, diarrhea and severe hematuria for three days. On physical examination the patient was dehydrated, with pale mucous membranes, uremic breath and abdominal pain. Blood tests showed mild anemia and azotemia. In both kidneys, abdominal ultrasonography exhibited a large hyperechoic structure with deep acoustic shadowing. These same structures were observed in abdominal radiographic examination as radiopaque structures, confirming the diagnosis of bilateral nephrolithiasis. Urine culture was positive for coagulase-negative Staphylococcus sp. The patient was stabilized with fluid therapy, antiemetic, analgesics, antibiotics and whole blood transfusion. Unilateral nephrotomy of the right kidney was performed to remove the urolith. After three months, nephrotomy of the left kidney was performed to remove the other urolith. The patient was clinically stable and with no macroscopic hematuria 12 h after surgery. Two days after discharge, the patient returned prostrated in lateral recumbency, however with no alteration of parameters in physical examination. Blood tests showed anemia, thrombocytopenia, hypoalbuminemia, azotemia and hyperphosphatemia. The dog presented a convulsive episode and died shortly, eight hours later. In the necropsy examination, extensive loss of renal parenchyma was seen in both kidneys and the presence of thrombosis and areas of infarction in several organs such as spleen, liver, lungs and central nervous system.Discussion: Complications of nephrotomy include perirenal hemorrhage, hydronephrosis due to obstruction of blood clots or urine leakage to the abdominal cavity. From the necropsy findings, the surgical site did not present these complications, justifying that the surgical procedure was not directly related to death. Correction of dehydration, blood transfusion, and antibiotic therapy based on urine culture and susceptibility testing was important for initial stabilization, before surgery. However, the presence of advanced chronic kidney disease may have contributed to deterioration of the patient's clinical condition and death. The presence of thrombus and hemorrhagic areas, observed during necropsy, associated with acute onset of clinical signs and the presence of severe hypoalbuminemia, may suggest that the patient died due to a thromboembolic event, as a consequence of nephrotic syndrome. Studies show that nephrotomy can be performed with few adverse effects on renal function if the surgical technique and anesthetic management are adequate. In this case, nephrotomy was the best option for the treatment of the patient, since it enabled a rapid intervention, controlled the hematuria and allowed the removal of both uroliths without complications related to surgery.

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“…For clamping of the hilum, our preference is to place two bulldog clamps on the renal artery alone, leaving the vein open. Previous studies had shown a benefit of hemostasis, as well as optimizing recovery of renal function and minimizing ischemia …”

Section: Instrumentationmentioning

confidence: 99%

Robotic partial nephrectomy: Current technique and outcomes

Wang

Lee

2013

Int J of Urology

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Over the past decade, management of the T1 renal mass has focused on nephron-sparing surgery. Robotic partial nephrectomy has played an increasing role in the technique of preserving renal function by decreasing warm ischemia time, as well as optimizing outcomes of hemorrhage and fistula. Robot-assisted partial nephrectomy is designed to provide a minimally-invasive nephron-sparing surgical option utilizing reconstructive capability, decreasing intracorporeal suturing time, technical feasibility and safety. Ultimately, its benefits are resulting in its dissemination across institutions. Articulated instrumentation and three-dimensional vision facilitate resection, collecting system reconstruction and renorrhaphy, leading to decreased warm ischemia time while preserving oncological outcomes. The aim of the present review was to present our surgical sequence and technique, as well as review the current status of robot-assisted partial nephrectomy.

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Clamping renal artery alone produces less ischemic damage compared to clamping renal artery and vein together in two animal models: near-infrared tissue oximetry and quantitation of 8-isoprostane levels

Cited by 12 publications

References 22 publications

Comparison of ischaemia–reperfusion‐induced acute kidney injury by clamping renal arteries, veins or pedicles in anaesthetized rats

Comparison of ischaemia–reperfusion‐induced acute kidney injury by clamping renal arteries, veins or pedicles in anaesthetized rats

Treatment of an Atypical Case of Bilateral Nephrolithiasis in a Canine

Robotic partial nephrectomy: Current technique and outcomes

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