Renoprotection against complete unilateral ureteric obstruction: Is there an ultimate choice?

Abstract

ObjectivesTo evaluate and compare the relative contribution of different therapeutic agents for renoprotection against complete unilateral ureteric obstruction (UUO), using a rabbit model sampled at different times.Materials and methodsEighty-four male New Zealand White rabbits were divided into seven groups of 12 rabbits; a sham group, a control (left UUO + no medication) or left UUO and treated with either enalapril, losartan, verapamil, l-arginine or antioxidant (vitamin E and selenium mixture). Rabbits in the control and treated groups were subjected to 3, 10 and 21 days of complete ureteric ligation and then killed humanely. The control and treated groups were evaluated at baseline and at the end of the experiment, by measuring split effective renal plasma flow (ERPF) using diuretic renography, and the split glomerular filtration rate (GFR) using selective creatinine clearance. Renal histopathology was evaluated using a tubulo-interstitial damage score.ResultsIn the sham group there was no significant effect on any of the evaluated variables. For split ERPF, losartan showed the highest renoprotective effect, saving 44% and 77% of ERPF at 3 and 21 days after UUO, respectively. Losartan was also the best renoprotective agent for GFR. For renal histopathology, enalapril showed the earliest and greatest improvement as assessed by the damage score, reaching 60% at 21 days after UUO. l-Arginine was the next best effect to blockade the renin-angiotensin system for renoprotection.ConclusionWe suggest that blockade of the renin-angiotensin system provides the best renoprotection against the effects of complete UUO.

The features of technetium-99m-DTPA renal dynamic imaging after severe unilateral ureteral obstruction in adult rabbits

“…However, there has been controversy regarding the use of RDI to assess the function of the hydronephrotic kidney. Lee et al [7] and Khalil et al [13] believed that renal function after UUO declined. This opinion has generally been accepted.…”

Does baseline renal function always decrease after unilateral ureteral severe obstruction? —experimental validation and novel findings by Tc-99m diethylene triamine pentaacetate acid (DTPA) dynamic renal scintigraphy

“…After unilateral ureteral partial obstruction, intrarenal pressure increases, and the renal pelvis and calyces further expand. Ureteral obstruction not only causes morphological changes in the kidneys but also affects their functions (2)(3)(4)(5)(6). The greatest hazard of obstruction is the resulting renal damage or even loss of renal function (2)(3)(4)(5)(6).…”

“…Ureteral obstruction not only causes morphological changes in the kidneys but also affects their functions (2)(3)(4)(5)(6). The greatest hazard of obstruction is the resulting renal damage or even loss of renal function (2)(3)(4)(5)(6). The changes in renal function after obstruction remain controversial.…”

“…The changes in renal function after obstruction remain controversial. Some scholars have found that renal function progressively declines in complete ureteral obstruction (3,4,6) and partial obstruction (7,8). Studies by Wang et al (5) and Claesson et al (9) showed that renal function drastically decreased in the early stage after partial obstruction and then tended to stabilize.…”

“…In this study, we systematically observed morphological changes in obstructed kidneys and the regularity of renal functional changes. We found that the baseline GFR of obstructed kidneys presented changing features that differed from those described in the literature (3)(4)(5)(6); moreover, we explored methods of evaluating the degree of impairment of obstructive renal function and predicting recoverability, as reported below.…”