Abstract
BackgroundMannitol has been employed to ameliorate renal warm ischemia damage during partial nephrectomy, however, there is limited scientific evidence to support the use of mannitol during partial nephrectomy. The objective of the present study was to investigate the glomerular number after renal warm ischemia, with and without the use of mannitol in a Pig Model.MethodsTwenty-four male pigs were assigned into three groups. Eight animals were allocated to the sham group that was subjected to laparoscopic dissection of the left renal hilum, without renal ischemia. Eight animals were allocated to the ischemia group that had the left renal hilum clamped for 30 min through laparoscopic access. Eight animals received mannitol (250 mg/kg) before the occlusion of renal hilum for 30 min. The kidneys were collected after the euthanasia of the pigs 21 days post surgery. The right kidney was utilized as a self-control for each animal. Serum creatinine, urea levels, the weight and volume of the kidneys were measured. Glomerular volumetric density, volume-weighted glomerular volume, and cortical volume were quantified through stereological methods and employed to determine the number of nephrons per kidney. Student’s t test and ANOVA were used for statistical analysis.ResultsIn the ischemia group, the left kidney recorded a reduction of 24.6% (290, 000 glomeruli) in the number of glomeruli in comparison to the right kidney. Kidneys subjected to ischemia also displayed decreased weight and volume in comparison to the sham and mannitol groups. No difference was observed between the left and right kidneys from the sham and mannitol groups. Further, no distinction in serum creatinine and urea among the groups was observed.ConclusionThe use of mannitol significantly reduces nephron loss during warm ischemia in pigs.
Highlights
Mannitol has been employed to ameliorate renal warm ischemia damage during partial nephrectomy, there is limited scientific evidence to support the use of mannitol during partial nephrectomy
There is limited scientific evidence to validate the application of mannitol to preserve kidney function during partial nephrectomy, almost 80% of groups that perform partial nephrectomy routinely apply mannitol as an ameliorating agent [9]
Renal function exhibits no difference in relation to mannitol administration during renal ischemia in Damasceno-Ferreira et al BMC Urology (2018) 18:16 partial nephrectomy [10, 11]
Summary
Mannitol has been employed to ameliorate renal warm ischemia damage during partial nephrectomy, there is limited scientific evidence to support the use of mannitol during partial nephrectomy. There is a lack of quantitative morphological studies exploring the effects of mannitol to ameliorate damage caused during renal warm ischemia. For this experiment, swine was employed as an animal model, since it is considered the most adequate model for comparison with human kidney’s anatomy and physiology [12, 13] the aim of this study was to investigate the number of glomeruli, applying an unbiased stereological method, post renal warm ischemia with and without the administration of mannitol, in a porcine model
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