Ischemic preconditioning protects the dog kidney from ischemia-reperfusion injury.

OBJECTIVE: To evaluate the effects of unilateral ischemic insult and ischemic preconditioning (IPC) on renal histology in a canine model. METHODS: 30 dogs were randomized into 4 groups. In group A (5 male controls) and group B (5 female controls), ischemia was induced by clamping both left renal arteries for 40 min. Dogs in group C (10 male cases) or group D (10 female cases) underwent 5 min of arterial clamping and 10 min of declamping prior to the final 40-min ischemia induction. Renal biopsy was prepared 48 h later and microscopically examined. RESULTS: The control groups (A and B) developed 40% frank necrosis, 60% moderate injury, and there was no intact renal tissue in this group with no difference between sexes. The IPC groups (C and D) revealed 55% moderate injury and 45% normal pathology; however, there was no frank necrosis among them. Better IPC protection in the female group was not statistically significant. CONCLUSION: An IPC schedule of 5-min ischemia and 10-min reperfusion improves ischemia-reperfusion injury from subsequent prolonged ischemia in a canine model.

Laparoscopic nephrolithotomy in a patient with crossed fused renal ectopia.

BACKGROUND: A 32-year-old man was referred to a tertiary care center for stone management. The patient had initially presented to his primary physician 3 months earlier with right flank pain of 2 month's duration. Abdominopelvic ultrasonography and intravenous urography had revealed left-to-right crossed fused renal ectopia with a 25 mm opaque stone in the crossed kidney. The patient had received two sessions of extracorporeal shock wave lithotripsy, which had failed to remove the renal stone. INVESTIGATIONS: Noncontrast CT, blood tests (hemoglobin and creatinine levels), abdominopelvic ultrasonography and intravenous urography. DIAGNOSIS: Left-to-right crossed fused ectopia with a 25 mm opaque renal stone in the anomalous kidney. MANAGEMENT: The patient underwent laparoscopic nephrolithotomy to remove the renal stone. Intravenous urography and abdominopelvic ultrasonography 1 month after surgery confirmed that the patient was stone free and had functional renal units. The patient will be followed up every 3 months with abdominopelvic ultrasonography for early detection of stone recurrence.

Comparison of the effects of captopril, tamoxifen and L-carnitine on renal structure and fibrosis after total unilateral ureteral obstruction in the rat.

OBJECTIVE: To compare the effects of captopril, tamoxifen and L-carnitine on renal structure and the collagen content of the unilateral obstructed kidney in the rat using unbiased stereological methods. MATERIAL AND METHODS: Rats (n=25) were assigned equally to one of five groups after ligation of the ureter: (i) normal controls (no hydronephrosis); (ii) positive controls (hydronephrotic rats without drug treatment); (iii) hydronephrotic rat with captopril treatment (CAP); (iv) hydronephrotic rats with L-carnitine treatment (L-CAR); and (v) hydronephrotic rats with tamoxifen treatment (TAM). Two weeks after unilateral ureteral obstruction the kidney was removed and histological sections were prepared. The kidney volume and the fractional volumes and absolute amounts of the cortex, medulla, tubules, renal corpuscles, vessels and fibrous tissue were determined using modern stereological techniques. RESULTS: Kidney volume increased in the CAP group in comparison with the other groups. The absolute volume of the tubules was the same in the CAP group compared to the normal control group. However, in the other experimental groups, the amount of tubules decreased. The absolute volumes of the renal corpuscles and vessels did not show any significant differences between groups. The absolute volume of fibrous tissue showed significant increases in all groups in comparison with the normal controls. There were no differences in the absolute amounts of fibrous tissue between the positive control, CAP and L-CAR groups, but in the TAM group the collagen content was decreased. CONCLUSIONS: Captopril preserved the amount of renal tubules and tamoxifen decreased fibrous tissue formation in unilateral obstructed kidneys but there were no differences in other hydronephrotic kidneys.

Open dismembered tubularized flap pyeloplasty: an effective and simple operation for treatment of ureteropelvic junction obstruction.

OBJECTIVE: To evaluate the success rate of dismembered tubularized flap pyeloplasty (DTFP) in the treatment of ureteropelvic junction obstruction (UPJO). PATIENTS AND METHODS: In a prospective study from August 2002 to September 2004, 15 patients with a mean age of 21 years (range 2-47) in whom UPJO had been diagnosed by sonography, excretory urography or diuretic renography and who had a large extrarenal pelvis, underwent operation via flank intercostal incision. The proximal ureter and renal pelvis were dissected and mobilized retroperitoneally, the site of UPJO was excised and the site of insertion of the ureter on the renal pelvis was closed with a stitch. A wide based renal pelvic flap was created and tubularized to bridge the upper ureteral defect. After insertion of a nephrostomy tube, a double-J tube was inserted as an internal ureteral stent and anastomosis of the tubularized flap to the spatulated upper ureter was done and the renal pelvis window was closed. Patients were followed 3, 6 and 12 months postoperatively. RESULTS: Mean operation time was 1 h and mean hospital stay was 3 days. The ureteral stent was removed 4 weeks after operation and at the same time a nephrostogram was done that showed a widely patent ureteropelvic junction with good renal pelvis drainage in 12 ( approximately 80%) of the cases, but in 3 cases (approximately 20%) passage of contrast materials was not seen. In these patients, methylene blue was injected via a nephrostomy tube and in 2 patients (14%) urine color turned blue 20 min later, but in 1 patient (7%) this test was also negative. The latter patient underwent percutaneous endopyelotomy later. Mean patient follow-up was 14 months. Follow-up excretory urography confirmed patent and unobstructed ureteropelvic junction in all patients. The overall success rate of DTFP was 93%. CONCLUSION: DTFP is a simple and effective procedure for patients with UPJO who have long or multiple upper ureteral strictures and a large extrarenal pelvis.