Infrarenal aortic-clamping after renal ischaemia aggravates acute renal failure

Eur J Clin Invest 2011; 41 (6): 605–615 Background  Renal failure is a frequent complication of juxtarenal abdominal aortic aneurysm (JAA)‐repair. During this operation, suprarenal aortic‐clamping is followed by infrarenal aortic‐clamping (below renal arteries) to restore renal flow, while performin...

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Published in:European journal of clinical investigation 2011-06, Vol.41 (6), p.605-615
Main Authors: Yeung, Kak K., Richir, Milan, Hanrath, Paul, Teerlink, Tom, Kompanowska-Jezierska, Elzbieta, Musters, Renė J. P., van Leeuwen, Paul A. M., Wisselink, Willem, Tangelder, Geert-Jan
Format: Article
Language:English
Subjects:
Acute Kidney Injury - etiology
Acute Kidney Injury - pathology
Animals
Aorta, Abdominal - surgery
Aortic Aneurysm, Abdominal - surgery
Asymmetrical dimethylarginine
cardiovascular physiology
Case-Control Studies
Constriction
Creatinine
ischaemia-reperfusion
Ischemia - surgery
Kidney - blood supply
Leukocytes
lipocalin-2
Postoperative Complications
Rats
Renal Artery - physiopathology
Renal Artery - surgery
renal failure
Reperfusion - adverse effects
suprarenal aortic-clamping
Vascular Surgical Procedures - adverse effects
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Summary:Eur J Clin Invest 2011; 41 (6): 605–615 Background  Renal failure is a frequent complication of juxtarenal abdominal aortic aneurysm (JAA)‐repair. During this operation, suprarenal aortic‐clamping is followed by infrarenal aortic‐clamping (below renal arteries) to restore renal flow, while performing the distal anastomosis. We hypothesized that infrarenal aortic‐clamping, despite restoring renal perfusion provokes additional renal damage. Materials and methods  We studied three groups of rats. After 45 min of suprarenal aortic‐clamping, group 1 had renal reperfusion for 90 min without aortic‐clamps (n = 7). In group 2, 45 min of suprarenal aortic‐clamping with a distal clamp on the aortic‐bifurcation was followed by 20 min of infrarenal aortic‐clamping. Renal reperfusion was continued for 70 min without aortic‐clamps (i.e. 90 min of renal reperfusion; n = 8). The sham‐group had no clamps (n = 7). We measured renal haemodynamics, functional parameters and tissue damage. Results  On suprarenal aortic‐clamp removal, renal artery flow, cortical flow and arterial pressures were higher in group 2 than in group 1. We detected increased tubular brush border damage, luminal lipocalin‐2 and 30–60% higher renal protein nitrosylation in group 2 when compared to group 1 (P 
ISSN:0014-2972
1365-2362
DOI:10.1111/j.1365-2362.2010.02448.x