Protective Effects of the Segmental Renal Artery Clamping Technique on Ischemia-Reperfusion Injury in db/db Diabetic Mice

Abstract

Renal ischemia-reperfusion (I/R) injury is inevitable in partial nephrectomy and other kidney surgeries, with a higher incidence in patients with renal insufficiency. This study aimed to investigate the protective effects of precise segmental renal artery clamping (SRAC) against renal I/R injury in db/db diabetic mice, compared with conventional renal artery clamping (RAC). Grape seed extract, a powerful free radical scavenger, was administered to diabetic mice for 4 weeks before operation in subgroups (30 mg/kg/d). The unilateral renal pedicle was ligatured, and I/R injury to the contralateral kidney was induced (ischemia for 30 min followed by reperfusion for 24 h). Blood glucose value, creatinine, blood urea nitrogen, and urine microalbumin/urine creatinine ratio increased gradually and showed no preoperative statistical differences among six subgroups. These parameters were significantly lower in the SRAC than in the RAC group 24 h postoperatively. Moreover, the nonischemic area in the SRAC group expressed less KIM-1 and TNF-α mRNA and also revealed minor histopathological damage induced by I/R. These findings suggest that SRAC effectively reduces early renal injury induced by I/R and accelerates the recovery of renal function in diabetic mice. Thus, SRAC may be an ideal technique in partial nephrectomy, especially for patients with diabetic nephropathy and other renal insufficiencies.

Lentivirus-Mediated Silencing of Src Homology 2 Domain-Containing Protein Tyrosine Phosphatase 2 Inhibits Release of Inflammatory Cytokines and Apoptosis in Renal Tubular Epithelial Cells Via Inhibition of the TLR4/NF-kB Pathway in Renal Ischemia-Reperfusion Injury

“…It is estimated that over 2 million deaths are caused by AKI every year globally, and the mortality rate of patients with severe AKI remains high at about 40 ~ 60% [5,6]. I/R injury, a metabolic disorder of cells, is caused by I/R and usually leads to renal dysfunction and destruction [7]. Currently, major therapeutic approaches used for treating AKI include renal transplantation, dialysis and stem cell transplantation [8].…”

The correlation between affected renal function and affected renal residual volume

“…The methods for renal hilar control have been confirmed to be safe and feasible. [3–7] Given the challenges of main renal artery clamping, other methods have emerged as novel techniques to facilitate minimally invasive surgery by blocking the delicate blood-supply of the tumor and reducing ischemia-reperfusion injury (IRI) to the residual nephron during the operation. Due to the economic burden of patients in certain places in China, the da Vinci Si Surgical System could not be implemented.…”

“…Due to the economic burden of patients in certain places in China, the da Vinci Si Surgical System could not be implemented. LPN is a minimally invasive procedure for small renal tumors, [7–10] and laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking (SRPN) has been the routine treatment in the Affiliated Hospital of Guizhou Medical University and the Third Central Hospital of Tianjin.…”

“…PN surgery has been widely used as a standard of care for localized small renal tumors, [2,7,11] but factors that affect postoperative renal function have been highlighted in previous researches. [12–14] Warm ischemic time (WIT) has been considered the main factor influencing postoperative renal function after PN for a long period of time, [12,15–17] and some articles [16,18,19] have concluded that IRI was the detriment of renal function after PN surgery in the early postoperative period.…”

A Novel Dorsal Slit Approached Non-Ischemic Partial Nephrectomy Method for a Renal Tissue Regeneration in a Mouse Model

“…Kidney ischemia-reperfusion during partial nephrectomy is a conventional method in mouse experiments [1]. However, this method can cause serious complications and is closely related to chronic renal dysfunction [2].…”