Avaliação da perda glomerular após isquemia quente arteriovenosa, arterial ou seletiva no modelo suíno

Abstract

The objective of this study was to evaluate, in pigs, the renal function repercussion after warm ischemia with selective arterial clamping (left renal artery caudal branch), through functional tests and morphometric stereological analysis, and compare with the results obtained after arteriovenous occlusion or isolated renal artery clamping. Thirty-two animals were randomly allocated into four groups (with eight animals in each group) were used in the study. In the control group (SHAM), both kidneys were exclusively submitted to pneumoperitoneum. In the (AV) group, the left renal artery and vein were clamped in block. In group (A), the left renal artery was singly clamped. And in group (S) the left renal artery caudal branch was selectively occluded. For all groups, the kidneys were submitted to 30 minutes of warm ischemia by a laparoscopic approach. The right kidney was not manipulated during the experiment and was used as control. The animals were euthanized after 21 days, and kidneys were collected. Renal fragments were processed for stereological morphometrical evaluetion. Glomerular mean volume (GMV), glomerular volume density (Vv [glom]), cortico-medullary analysis, glomerular density and number of nephrons were assessed. Creatinine and urea serum levels were also assessed preoperatively, 10 days after surgery and before euthanasia. In AV group was observed a reduction of 24.5% in the Vv [Glom] of the left kidney and a reduction of 25.4% and 19.2% in the VGM and number of glomeruli, respectively, when compared to the right kidney. Similarly, when compared the Vv [Glom], GMV and Nv (glom / rim) of the left kidney AV group with those of the SHAM, A and S groups, a significant decrease was found. On the other hand, in the present study, the selective arterial clamping technique was not superior to isolated renal artery occlusion. There was no significant difference in serum creatinine and urea levels at the different moments of the experiment. Based on this study, arterial or selective clamping techniques should be preferred in relation to arteriovenous clamping, since they have a lower glomerulus deleterious effect. Moreover, in the present study, the technique of selective arterial occlusion did not bring any benefit, when compared to the clamping of the main renal artery.