Infrarenal aortic-clamping after renal ischaemia aggravates acute renal failure
Version of Record online: 15 DEC 2010
© 2010 The Authors. European Journal of Clinical Investigation © 2010 Stichting European Society for Clinical Investigation Journal Foundation
European Journal of Clinical Investigation
Volume 41, Issue 6, pages 605–615, June 2011
How to Cite
Yeung, K. K., Richir, M., Hanrath, P., Teerlink, T., Kompanowska-Jezierska, E., Musters, R. J. P., van Leeuwen, P. A. M., Wisselink, W. and Tangelder, G.-J. (2011), Infrarenal aortic-clamping after renal ischaemia aggravates acute renal failure. European Journal of Clinical Investigation, 41: 605–615. doi: 10.1111/j.1365-2362.2010.02448.x
- Issue online: 3 MAY 2011
- Version of Record online: 15 DEC 2010
- Received 1 July 2010; accepted 10 November 2010
- Asymmetrical dimethylarginine;
- cardiovascular physiology;
- renal failure;
- suprarenal aortic-clamping
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 < 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.