The Intrinsic Renal Compartment Syndrome: New Perspectives in Kidney Transplantation

Herrler, Tanja; Tischer, A.; Meyer, Axel; Feiler, Sergej; Guba, Markus; Nowak, S.; Rentsch, Markus; Bartenstein, Peter; Hacker, Marcus; Jauch, Karl‐Walter

doi:10.1097/tp.0b013e3181c40aba

Cited by 86 publications

(61 citation statements)

References 16 publications

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“…It is assumed that the raised pressure exerted on the transplanted kidney increases the intracapsular pressure, vascular resistance, and the inversion of the wave diastolic flow in the renal artery, thus reducing the blood supply to the graft, with the consequent reduction or loss of function. This hypothesis was supported by experimental studies carried out [14] on transplanted mice by Herrler et al, in which the ischemia-reperfusion injury that raises of intracapsular pressure and decreases renal flow and tubular function can be resolved through a polar capsulotomy of the kidney [15].…”

Section: Clinical Presentation Of Racssupporting

confidence: 62%

Renal Allograft Compartment Syndrome: Is It Possible to Prevent?

Damiano

Maione

Maffongelli

et al. 2016

Transplantation Proceedings

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Renal allograft compartment syndrome (RACS) is a complication characterized by increased pressure over 15 to 20 mm Hg of the iliac fossa site of transplanted kidney that can lead to a reduction of the blood supply to the graft, resulting in organ ischemia. This study aims to evaluate, through a review of the literature, the incidence, detection, treatment, and possible prevention of RACS. The incidence of this complication, which appears generally in the immediate post-transplantation period, is currently approximately 1% to 2% and is underestimated because of poor nosography for the presence of symptoms common to other post-transplantation complications. Doppler ultrasound is indispensable to evaluate the graft function in the immediate postoperative period and in the following days. The onset of RACS involves a surgical decompression of the graft and the subsequent closure of the abdominal wall with tension-free technique. Several authors agree that only the immediate surgical decompression following an early diagnosis can ensure a recovery of the graft. Early detection of the RACS is the key to preventing the loss of the graft. It is desirable to prevent this syndrome by reducing the discrepancy in weight between donor and recipient by 17%. However the shortage of organs makes such a selection not easy; therefore, in cases at risk for RACS, a close instrumental and clinical monitoring of the patient during post-transplantation recovery is recommended, so a prompt surgical decompression can be performed if RACS is suspected.

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Section: Clinical Presentation Of Racssupporting

confidence: 62%

Renal Allograft Compartment Syndrome: Is It Possible to Prevent?

Damiano

Maione

Maffongelli

et al. 2016

Transplantation Proceedings

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“…Interstitial edema induced by saline can cause subcapsular pressure elevation in the kidney and cause renal ischemia (Herrler et al, 2010). The ischemia can induce regional activation of renin-angiotensin system (RAS), which increases proximal NaCl absorption and simultaneously enhances TGF activity causing further afferent arterial vasoconstriction (Mitchell and Navar, 1988) and reduction in the glomerular filtration rate (Mitchell and Navar, 1990).…”

Section: Pathological Effects Of Saline On Renal Hemodynamicsmentioning

confidence: 99%

0.9% saline is neither normal nor physiological

Sun

Yap

et al. 2016

J. Zhejiang Univ. Sci. B

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Abstract:The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline (henceforth: saline) and to discuss the impact of saline infusion, specifically on systemic acid-base balance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume (>2 L) saline infusion in healthy adults induces hyperchloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload (80 ml/kg) in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger (NHE) and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemodynamics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising O 2 delivery to the renal parenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, increases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastrointestinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.

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“…Although mouse imaging using about 37 MBq 99m Tc-MAG 3 was reported in previous studies, clear renal images were not obtained, as gamma camera and clinical scanner using NaI detector with PAH were applied for 99m Tc-MAG 3 imaging with mice [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…In current SPECT scanners, cadmium zinc telluride (CZT) semiconductor detectors have been applied to improve energy and spatial resolution [4][5][6][7][8], as compared with sodium iodide (NaI) scintillation detectors, which were used in conventional SPECT scanners [9][10][11][12][13][14][15][16][17][18][19]. Planar and SPECT projection data are acquired using various collimators in clinical settings.…”

Section: Introductionmentioning

confidence: 99%

Appropriate collimators in a small animal SPECT scanner with CZT detector

et al. 2013

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word count: 268; Total word count: 3238 Short title: Comparison of collimators Abstract ObjectiveAlmost all small-animal SPECT is performed with pinhole collimators (PH), including single-PH (SPH) and multi-PH (MPH). In the clinical study, not only PH but also parallel-hole collimator (PAH) is often used in planar and SPECT imaging.However, there have been no comparative studies on image quality with various collimators on the small-animal imaging.This study compared the basic characteristics of PH and PAH in small-animal imaging. MethodsPerformance of planar and SPECT imaging were evaluated using 99mTcO 4 -and SPH, MPH and PAH with low energy and high resolution on the SPECT/CT scanner FX3200.We measured sensitivity, resolution, concentration linearity and uniformity. Tc-MDP-SPECT images than SPH and PAH. ConclusionsThe characteristics of PH and PAH differed on small-animal imaging. Although sensitivity was higher with PAH, PH showed higher resolution. Among the PH collimators, SPH was more appropriate for planar imaging, and MPH was more suitable for SPECT imaging in a small animal imaging scanner with CZT detector.

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The Intrinsic Renal Compartment Syndrome: New Perspectives in Kidney Transplantation

Cited by 86 publications

References 16 publications

Renal Allograft Compartment Syndrome: Is It Possible to Prevent?

Renal Allograft Compartment Syndrome: Is It Possible to Prevent?

0.9% saline is neither normal nor physiological

Appropriate collimators in a small animal SPECT scanner with CZT detector

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