Persistent renin-angiotensin system activation after anti-reflux surgery and its management

Sinha

et al. 2013

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Aims:To study, the effects of ipsilateral ureteric obstruction on contralateral kidney and the role of renin angiotensin system (RAS) blockade on renal recovery in experimentally induced unilateral ureteric obstruction.Materials and Methods:Unilateral upper ureteric obstruction was created in 96 adult Wistar rats that were reversed after pre-determined intervals. Losartan and Enalapril were given to different subgroups of rats following relief of obstruction.Results:The severity of dilatation on the contralateral kidney varied with duration of ipsilateral obstruction longer the duration more severe the dilatation. There is direct correlation between renal parenchymal damage, pelvi-ureteric junction (PUJ) fibrosis, inflammation and severity of pelvi-calyceal system dilatation of contralateral kidney with duration of ipsilateral PUJ obstruction.Conclusions:Considerable injury is also inflicted to the contralateral normal kidney while ipsilateral kidney remains obstructed. Use of RAS blocking drugs has been found to significantly improve renal recovery on the contralateral kidney. It can, thus, be postulated that contralateral renal parenchymal injury was mediated through activation of RAS.

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Section: Discussionmentioning

confidence: 99%

Effect of ipsilateral ureteric obstruction on contralateral kidney and role of renin angiotensin system blockade on renal recovery in experimentally induced unilateral ureteric obstruction

Panda

Sinha

et al. 2013

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“…It has recently been demonstrated that use of RAS blockade can retard the pace of clinical renal damage[20] as well as minimise experimentally created damage. [13] The present study further provides proof of mechanism that use of drugs acting on RAS could be useful even in reversing pathological changes caused after a period of experimentally created obstruction.…”

Section: Discussionmentioning

confidence: 99%

Unilateral ureteric obstruction: Role of renin angiotensin system blockade on renal recovery: An experimental study

Sinha

Panda

et al. 2012

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Aims:To study and compare the effects of angiotensin II antagonist (Losartan) and angiotensin converting enzyme (ACE) inhibitor (Enalapril) on renal recovery following reversal of iatrogenic unilateral upper ureteric obstruction.Materials and Methods:Unilateral upper ureteric obstruction was created in 96 adult Wistar rats that were reversed after predetermined intervals. Losartan and Enalapril were given to different subgroups of rats following relief of obstruction. Rats were sacrificed and kidneys were subjected to planimetric and histopathological analysis.Results:Dorsal lumbotomy approach provided a rapid and safe approach to kidneys in rats. The planimetric and histopathological changes were most severe in the group of rats in whom obstruction was not relieved before sacrifice. Addition of Enalapril and Losartan significantly hastened the reversal of renal changes following relief of obstruction as compared with the group in which no treatment was given following reversal of blockade.Conclusions:Renin angiotensin system (RAS) is the major pathway responsible for renal damage following outflow obstruction. However, this damage can be reversed with the use of drugs acting on the RAS.

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“…Not only this, a subset of patients showed a resurgence of RAS activation after initial postsurgical fall, reflected by way of rising PRA and falling GFR. [ 10 ] With therapy by RAS inhibitors, we demonstrated the benefits of RAS inhibitors in retrieving lost renal function. [ 10 11 ]…”

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confidence: 99%

“…[ 10 ] With therapy by RAS inhibitors, we demonstrated the benefits of RAS inhibitors in retrieving lost renal function. [ 10 11 ]…”

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confidence: 99%

Congenital anomalies of the kidney and urinary tract, biomarkers, and chronic kidney disease in children: A trajectory for the surgeon-scientists of the next generation

Anand

2022

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