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Infrarenal aortic‐clamping after renal ischaemia aggravates acute renal failure
Author(s) -
Yeung Kak K.,
Richir Milan,
Hanrath Paul,
Teerlink Tom,
KompanowskaJezierska Elzbieta,
Musters Renė J. P.,
van Leeuwen Paul A. M.,
Wisselink Willem,
Tangelder GeertJan
Publication year - 2011
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2010.02448.x
Subject(s) - medicine , renal artery , cardiology , renal ischemia , renal blood flow , aortic aneurysm , clamp , kidney , abdominal aortic aneurysm , aorta , ischemia , anesthesia , aneurysm , surgery , reperfusion injury , clamping , mechanical engineering , engineering
Eur J Clin Invest 2011; 41 (6): 605–615 Abstract 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 < 0·05). Group 2 showed more release of asymmetrical dimethylarginine (ADMA) from the kidneys in the renal vein, therefore indicating diminished clearing capacity ( P < 0·001). Arginine/ADMA‐ratio, which defines the bio‐availability of nitric oxide, tended to be lower in group 2 and correlated with renal flow. Furthermore, there were no significant differences found in creatinine levels and renal leucocyte accumulation between group 1 and 2. Conclusions Additional infrarenal aortic‐clamping leads to increased renal damage and oxidative stress, despite adequate perfusion of kidneys after suprarenal aortic‐clamping. This study indicates that the clamping sequence used in JAA‐repair causes more than simple renal I/R‐injury.