After the first two years of renal replacement therapy, transplantation demonstrates lower costs to the system when compared to other modalities evaluated. Based on that, this therapy justifies improvements in government policies in this sector.

ABSTRATCPurpose: This study has analyzed the giochemical and morphological effects on the remmant kidney in rats which were submitted to progressive surgical ablation of renal mass. Methods: Sixty Wistar male rats, weighing between 210 and 380g, were used and they were distributed in 3 groups of 20 animals each. The rats from the groups called 1, 2 and 3 were submitted to the surgical removal of renal tissue equivalent to ½, 2/3 and 5/6 of the whole renal mass, respectively. Then the groups were subdivided into 2 subgroups and they were operated again within 24 hours (subgroups 1B, 2B and 3B) and within 8 weeks (subgroups 1C, 2C and 3C) for the removal of the remnant kidney. 24-hour urine and blood were collected to analyze serum creatinine, clearance of creatinine and proteinuria in the first surgical intervention and at the time of the re-operation. The remnant kidney was submitted to a macroscopic evaluation for the degree of hypertrophy and to the analysis of histology. Results: There was a significant increase of the volume of the remnant kidney (164%) and glomerular sclerosis was present in 40% of the animals submitted to the ablation of 5/6 of renal mass. Functional alterations characterized by the increase of urinary excretion of proteins (50% in group 3), rise in the serum creatinine (261% subgroup 2B; 371% subgroup 3B, 118% subgroup 3C) and a significant reduction of the clearance of creatinine (control x subgroup 3C = 2,88 x 1,15 ml/min: p<0,05 were also observed. Conclusion: The compensatory renal hypertrophy, as well as the glomerular injury translated in the form of proteinuria and sclerosis, are closed related to the volume of the remnant kidney, thus they are more evident when a greater fraction of the renal tissue is excised. Key words: Kidney. Nephrectomy. Surgery. Creatinine. Rats. RESUMOObjetivo: O estudo analisou os efeitos bioquímicos e morfológicos sobre o rim remanescente em ratos submetidos à ablação cirúrgica progressiva da massa renal. Métodos: Foram utilizados 60 ratos machos Wistar, pesando entre 210 e 380g, distribuídos em 3 grupos contendo 20 animais cada. Os ratos dos grupos denominados de 1,2 e 3 foram submetidos à remoção cirúrgica de tecido renal equivalente a ½, 2/3 e 5/6 da massa renal total, respectivamente. Os grupos foram então subdivididos em 2 subgrupos e reoperados em 24 horas (subgrupos 1B, 2B, 3B) e em 8 semanas (subgrupos 1C, 2C, 3C) para remoção do rim remanescente. Foram obtidas coletas de urina de 24 horas e sangue para análise da creatinina sérica, depuração da creatinina e proteinúria na primeira intervenção cirúrgica e por ocasião da reoperação. O rim remanescente foi submetido à avaliação macroscópica do grau de hipertrofia e à análise histológica. Resultados: Houve aumento significativo do volume do rim remanescente (164%) e presença de esclerose glomerular em 40% dos animais submetidos à ablação de 5/6 da massa renal. Alterações funcionais caracterizadas pelo aumento da excreção urinária de proteínas (50% no grupo 3), elevação dos níveis séricos da creatinin...

OBJECTIVE:Prolonged warm ischemia time and increased intra-abdominal pressure caused by pneumoperitoneum during a laparoscopic donor nephrectomy could enhance renal ischemia reperfusion injury. For this reason, laparoscopic donor nephrectomy may be associated with a slower graft function recovery. However, an adequate protective response may balance the ischemia reperfusion damage. This study investigated whether laparoscopic donor nephrectomy modified the protective response of renal tissue during kidney transplantation.METHODS:Patients undergoing live renal transplantation were prospectively analyzed and divided into two groups based on the donor nephrectomy approach used: 1) the control group, recipients of open donor nephrectomy (n = 29), and 2) the study group, recipients of laparoscopic donor nephrectomy (n = 26). Graft biopsies were obtained at two time points: T-1 = after warm ischemia time and T+1 = 45 minutes after kidney reperfusion. The samples were analyzed by immunohistochemistry for the Bcl-2 and HO-1 proteins and by real-time polymerase chain reaction for the mRNA expression of Bcl-2, HO-1 and vascular endothelial growth factor. RESULTS:The area under the curve for creatinine and delayed graft function were similar in both the laparoscopic and open groups. There was no difference in the protective gene expression between the laparoscopic donor nephrectomy and open donor nephrectomy groups. The protein expression of HO-1 and Bcl-2 were similar between the open and laparoscopic groups. Furthermore, the gene expression of B-cell lymphoma 2 correlated with the warm ischemia time in the open group (p = 0.047) and that of vascular endothelial growth factor with the area under the curve for creatinine in the laparoscopic group (p = 0.01).CONCLUSION:The postoperative renal function and protective factor expression were similar between laparoscopic donor nephrectomy and open donor nephrectomy. These findings ensure laparoscopic donor nephrectomy utilization in renal transplantation.

The function and renal morphology of rats submitted to a unilateral nephrectomy were not significantly influenced by prolonged and successive pneumoperitoneum, according to this study's biochemical and histological findings.