Segmental Renal Artery Research Articles

Variations in the Branching Pattern of Segmental Renal Arteries on 64 Slice MDCT

Variations in the Branching Pattern of Segmental Renal Arteries on 64 Slice MDCT

Acoustic Radiation Force Impulse Imaging of the Transplant Kidney: Correlation Between Cortical Stiffness and Arterial Resistance in Early Post-transplant Period

BackgroundAcoustic radiation force impulse (ARFI) imaging is a noninvasive imaging modality for quantitative assessment of tissue stiffness. This study utilized ARFI imaging to assess the stiffness of a transplant renal cortex within the first month after renal transplantation and to explore the correlation between the cortical stiffness and arterial resistance of the transplant kidney. MethodsForty renal transplant recipients (male/female = 26/14; mean age: 45.3 years; deceased donor/living related donor = 27/13) were included in this study. ARFI imaging with virtual touch tissue imaging quantification was applied to assess the stiffness of the transplant renal cortex by using a linear ultrasound transducer. Arterial resistance was acquired by spectral Doppler examination of the main artery and intrarenal arteries of the transplant kidney using a curvilinear ultrasound transducer. ResultsThe stiffness of transplant renal cortex was expressed as shear wave velocity (m/s). The mean value of cortical stiffness was 3.19 ± 1.01 m/s (range: 1.55–5.54). The stiffness of transplant renal cortex was positively correlated with the resistance index of the main renal artery (r = 0.55, P = .001), segmental artery (r = 0.43, P = .005), and interlobar artery (r = 0.42, P = .006). ConclusionThe stiffness of a transplant renal cortex is positively correlated with the arterial resistance of the renal transplant in the early post-transplant period. This result indicates that, in addition to renal fibrosis, the stiffness of the transplant renal cortex is also influenced by the hemodynamics of the transplant kidney.

Impacts of Renal Sympathetic Activation on Atrial Fibrillation: The Potential Role of the Autonomic Cross Talk Between Kidney and Heart

BackgroundRecent studies have demonstrated that there is a high variability of renal sympathetic nerve density distribution from proximal to distal renal artery segments. The aim of our study was to investigate the roles of renal sympathetic nerve stimulation (RSS) on atrial fibrillation and cardiac autonomic nervous activity.Methods and ResultsTwenty‐eight dogs were randomly assigned to the proximal RSS group (P‐RSS, N=7), middle RSS group (M‐RSS, N=7), distal RSS group (D‐RSS, N=7), and the control group (sham RSS, N=7). RSS was performed using electrical stimulation on the bilateral renal arteries for 3 hours. Effective refractory period and the window of vulnerability were measured at atrial and pulmonary veins sites. Superior left ganglionated plexi (SLGP) and left stellate ganglion (LSG) function and neural activity were determined. C‐fos and nerve growth factor protein expression in the SLGP and LSG were examined. Only P‐RSS (1) caused pronounced blood pressure rises, induced a significant decrease in effective refractory period, and generated a marked increase in cumulative window of vulnerability and effective refractory period dispersion; (2) increased the frequency and amplitude of the neural activity in the SLGP and LSG; (3) increased SLGP and LSG function; and (4) upregulated the level of c‐fos and nerve growth factor expression in the SLGP and LSG.ConclusionsThis study demonstrated that renal sympathetic nerve activation induced by 3 hours of P‐RSS facilitated atrial fibrillation inducibility by upregulating cardiac autonomic nervous activity, suggesting a potential autonomic cross talk between kidney and heart.

Endothelial overexpression of endothelin-1 modulates aortic, carotid, iliac and renal arterial responses in obese mice.

Endothelin-1 (ET-1) is essential for mammalian development and life, but it has also been implicated in increased cardiovascular risk under pathophysiological conditions. The aim of this study was to determine the impact of endothelial overexpression of the prepro-endothelin-1 gene on endothelium-dependent and endothelium-independent responses in the conduit and renal arteries of lean and obese mice. Obesity was induced by high-fat-diet (HFD) consumption in mice with Tie-1 promoter-driven, endothelium-specific overexpression of the prepro-endothelin-1 gene (TEThet) and in wild-type (WT) littermates on a C57BL/6N background. Isometric tension was measured in rings (with endothelium) of the aorta (A), carotid (CA) and iliac (IA) arteries as well as the main (MRA) and segmental renal (SRA) arteries; all experiments were conducted in the absence or presence of L-NAME and/or the COX inhibitor meclofenamate. The release of prostacyclin and thromboxane A2 was measured by ELISA. In the MRA, TEThet per se increased contractions to endothelin-1, but the response was decreased in SRA in response to serotonin; there were also improved relaxations to acetylcholine but not insulin in the SRA in the presence of L-NAME. HFD per se augmented the contractions to endothelin-1 (MRA) and to the thromboxane prostanoid (TP) receptor agonist U46619 (CA, MRA) as well as facilitated relaxations to isoproterenol (A). The combination of HFD and TEThet overexpression increased the contractions of MRA and SRA to vasoconstrictors but not in the presence of meclofenamate; this combination also augmented further relaxations to isoproterenol in the A. Contractions to endothelin-1 in the IA were prevented by endothelin-A receptor antagonist BQ-123 but only attenuated in obese mice by BQ-788. The COX-1 inhibitor FR122047 abolished the contractions of CA to acetylcholine. The release of prostacyclin during the latter condition was augmented in samples from obese TEThet mice and abolished by FR122047. These findings suggest that endothelial TEThet overexpression in lean animals has minimal effects on vascular responsiveness. However, if comorbid with obesity, endothelin-1-modulated, prostanoid-mediated renal arterial dysfunction becomes apparent.

Application of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for patients with multiple renal tumors

Objective To explore the feasibility and safety of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for the patients with multiple renal tumors and solitary kidney or contralateral kidney insufficiency. Methods Seven patients who have undergone retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping between October 2010 and October 2016 were retrospectively analyzed, and clinical materials and parameters during and after the operation were summarized, including operation time, clamping time of segmental renal artery, blood loss during the operation, complications and renal function after the operation. Results Fifteen tumors were resected in 7 patients and the operations were all successful. The operation time ranged from 100 to 180 minutes with the average of 125 minutes; clamping time of segmental renal artery was 10-30 minutes with the average of 23 minutes; the amount of blood loss during the operation was 120-330 ml with the average of 190 ml; hospital stay after the operation is 3-6 d with the average of 5 d. There was no complication during the perioperative period, and the pathology diagnosis after the surgery showed that there were 4 renal clear cell carcinomas, 1 papillary carcinoma and 2 perivascular epithelioid cell tumors and the margins were all negative. All patients were followed up for 3-60 months, and no local recurrence or metastasis was detected, and the creatinine was 102-187 μmol/L at 3 months after operation. Conclusions For the patients with multiple renal tumors and solitary kidney or contralateral kidney insufficiency, retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping was feasible and safe, which minimized the hot ischemia injury to the kidney and preserved the renal function effectively. Key words: Kidney neoplasms; Retroperitoneal laparoscopic operation; Partial nephrectomy; Segmental renal artery; Sequential clamping

Angiotensin-(1–7)-dependent vasorelaxation of the renal artery exhibits unique angiotensin and bradykinin receptor selectivity

Angiotensin-(1–7) [Ang-(1–7)] exhibits blood pressure lowering actions, inhibits cell growth, and reduces tissue inflammation and fibrosis which may functionally antagonize an activated Ang II-AT1 receptor axis. Since the vascular actions of Ang-(1–7) and the associated receptor/signaling pathways vary in different vascular beds, the current study established the vasorelaxant properties of the heptapeptide in the renal artery of male Wistar male rats. Ang-(1–7) produced an endothelium-dependent vasodilator relaxation of isolated renal artery segments pre-contracted by a sub-maximal concentration of phenylephrine (PE) (3×10−7M). Ang-(1–7) induced vasodilation of the rat renal artery with an ED50 of 3±1nM and a maximal response of 42±5% (N=10). The two antagonists (10−5M each) for the AT7/Mas receptor (MasR) [D-Pro7]-Ang-(1–7) and [D-Ala7]-Ang-(1–7) significantly reduced the maximal response to 12±1% and 18±3%, respectively. Surprisingly, the AT2R receptor antagonist PD123319, the AT1R antagonist losartan and B2R antagonist HOE140 (10−6M each) also significantly reduced Ang-(1–7)-induced relaxation to 12±2%, 22±3% and 14±7%, respectively. Removal of the endothelium or addition of the soluble guanylate cyclase (sGC) inhibitor ODQ (10−5M) essentially abolished the vasorelaxant response to Ang-(1–7) (10±4% and 10±2%, P <0.05). Finally, the NOS inhibitor LNAME (10−4M) reduced the response to 13±2% (p<0.05), but the cyclooxygenase inhibitor indomethacin failed to block the Ang-(1–7) response. We conclude that Ang-(1–7) exhibits potent vasorelaxant actions in the isolated renal artery that are dependent on an intact endothelium and the apparent stimulation of a NO-sGC pathway. Moreover, Ang-(1–7)-dependent vasorelaxation was sensitive to antagonists against the AT7/Mas, AT1, AT2 and B2 receptor subtypes.

СЛУЧАЙ УСПЕШНОЙ РЕВАСКУЛЯРИЗАЦИИ ПОЧКИ МЕТОДОМ АОРТО-ПОЧЕЧНОГО ШУНТИРОВАНИЯ

The article describes the case of successful revascularization of the right kidney by the method of autovenous aortorenal shunting. According to the data of renal duplex scanning, the patient showed signs of a size reducing of the right kidney with a decrease in blood flow velocity and resistance indices in the renal artery. Results of spiral computed tomography demonstrated the subtotal stenosis of the right renal artery up to 95% and preservation of the excretory function of the kidney. During the angiography an occlusion of the proximal segment of the right renal artery was detected, and an attempt of recanalization for subsequent stenting was failed. As a consequence, an open revascularization – autovenous aortorenal shunting was performed using laparotomy access. In the short- and mid-term periods, normalization of arterial pressure and satisfactory patency of the autovenous shunt were noted. In the opinion of the authors, in case of obliteration of the proximal segment of the renal artery caused by arteritis, open revascularization is a procedure of choice that provides radical restoration of the main blood circulation of the organ.

Downregulation of Thromboxane A2 Receptor Occurs Mainly via Nuclear Factor-KappaB Signaling Pathway in Rat Renal Artery.

Thromboxane A2 (TXA2) acts on TXA2 receptors (TP) to regulate renal artery blood flow and subsequently contributes to the pathogenesis of renal ischemia. The present study was designed to examine if nuclear factor-kappaB (NF-κB) signaling pathway is involved in the downregulation of TP receptors in rat renal artery. Rat renal artery segments were organ cultured for 6 or 24 h. Downregulation of TP receptors was monitored using myograph (contractile function), real-time PCR (receptor mRNA), and immunohistochemistry (receptor protein). Specific inhibitors (MG-132 and BMS345541) for NF-κB signaling pathway were used to dissect the underlying molecular mechanisms involved. Compared to fresh (noncultured) segments, organ culture of the renal artery segments for 24 h induced a significant rightward shift of U46619 (TP receptor agonist) contractile response curves (pEC50: 6.89 ± 0.06 versus 6.48 ± 0.04, P < 0.001). This decreased contractile response to U46619 was paralleled with decreased TP receptor mRNA and protein expressions in the renal artery smooth muscle cells. Specific inhibitors (MG-132 and BMS345541) for NF-κB signaling pathway significantly abolished the decreased TP protein expression and receptor-mediated contractions. In conclusion, downregulation of TP receptors in the renal artery smooth muscle cells occurs mainly via the NF-κB signaling pathway.

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

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.

Aortic floating thrombus detected by computed tomography angiography incidentally: Five cases and a literature review

ObjectiveTo analyze the findings of aortic floating thrombus (AFT) on computed tomography angiography (CTA) for a definitive, timely diagnosis and to select a reasonable management course to improve prognosis. MethodWe retrospectively analyzed imaging findings of 5 patients with AFT detected by CTA, including location, morphology, size, involved aortic segment, concomitant embolism, stent, and dynamic changes during the follow-up. ResultsSeven lesions were detected in the initial CTA studies of the 5 patients: 5 aortic intraluminal floating thrombi (3 patients) and 2 aortic in-stents floating thrombi (ASFTs; 2 patients). One aortic intraluminal floating thrombus was located in the right anterior wall of the ascending aorta and 2 in the aortic isthmus. Interval increasing in size of the splenic embolism and a new renal segmental artery embolism were noted in 1 patient after 7 days anticoagulation therapy. One ASFT was located in the original narrowing part of the aortic stent and another in the overlap of the stents. During the follow-up, some lesions disappeared, whereas the morphology and size varied in others. Four new ASFTs occurred. All the lesions were attached to the focal thickened inner walls of the stents with the free-floating portions along the direction of blood flow. ConclusionsAFT is a rare, life-threatening disease. Abnormal coagulation function, aortic disease, and history of aortic stent implantation are the potential predictors for AFT. CTA scanning can depict the lesions clearly and evaluate curative efficacy. The therapeutic strategy should be based on the etiology and the patient's physical condition, whereas the preferred treatment is conservative medication.

Bleeding post-transplantation intrarenal pseudoaneurysms

We herein present a case of an intrarenal pseudoaneurysm developing 2 weeks after renal transplantation. The patient presented with hemorrhagic shock. Computed tomography confirmed an intrarenal pseudoaneurysm with extravasation of contrast and a large surrounding hematoma. Angiography confirmed the pseudoaneurysm, and embolization of the segmental graft renal artery was performed. In view of the uncertain etiology and the possibility of a mycotic pseudoaneurysm, we administered empiric antimicrobial therapy. The clinical course, investigations, and management are described. Finally, a review of the literature regarding post-transplantation pseudoaneurysms is presented.以下是一宗於移植後 2 週出現的腎內僞動脈瘤個案，患者以出血性休克表現。當時為其安排緊急電腦斷層攝影 (CT)，發現有一個腎內僞動脈瘤，並呈現顯影劑溢出現象，且被一大型血腫圍繞。緊急血管攝影證實為植入腎之僞動脈瘤，同時我們對涉及的節段性動脈予以栓塞處置。基於病因並不明確，而且不能排除黴菌性僞動脈瘤的可能性，因此我們實施了經驗性抗微生物學療法。在本文中，我們描述了本個案的臨床歷程、相關檢查及後續處置，並指出我們在治療上所遭遇到的困難。最後，我們對移植後僞動脈瘤的相關文獻作出了回顧。

The Renal Arterial Resistance Index Predicts Worsening Renal Function in Chronic Heart Failure Patients

Background/Aim: The renal arterial resistance index (RRI) is a Doppler measure, which reflects abnormalities in the renal blood flow. The aim of this study was to verify the value of RRI as a predictor of worsening renal function (WRF) in a group of chronic heart failure (CHF) outpatients. Methods: We enrolled 266 patients in stable clinical conditions and on conventional therapy. Peak systolic velocity and end diastolic velocity of a segmental renal artery were obtained by pulsed Doppler flow, and RRI was calculated. Creatinine serum levels were evaluated at baseline and at 1 year, and the changes were used to assess WRF occurrence. Results: During follow-up, 34 (13%) patients showed WRF. RRI was associated with WRF at univariate (OR: 1.13; 95% CI: 1.07-1.20) as well as at a forward stepwise multivariate logistic regression analysis (OR: 1.09; 95% CI: 1.03-1.16; p = 0.005) including the other univariate predictors. Conclusions: Quantification of arterial renal perfusion provides a new parameter that independently predicts the WRF in CHF outpatients. Its possible role in current clinical practice to better define the risk of cardiorenal syndrome progression is strengthened.

ОСОБЕННОСТИ ПОЧЕЧНОГО КРОВОТОКА У БОЛЬНЫХ МНОЖЕСТВЕННОЙ МИЕЛОМОЙ НА РАЗНЫХ ЭТАПАХ ОПУХОЛЕВОЙ ПРОГРЕССИИ

The features of renal hemodynamics in 90 patients with multiple myeloma (MM) at different stages of tumor progression have been studied. The signs of renal hemodynamics disorder by ultrasound Dopplermetry data are already revealed at the first stages of MM. In the I and IIA stages there were diagnosed the following changes: the increase in average blood flow velocity (Vave) at the level of the interlobular arteries (20%); the reduction of peak systolic velocity (Vmax) at the level of arteries arc (11.4%); the drop of Vmax (24.5%), of Vave (11%), of diastolic velocity (Vmin) by 26% on interlobular arteries; the decrease of Vmin (26%) on segmental and main renal arteries. There was also revealed an increase in the indices of vascular resistance index (IR by 11%, IP by 13%) and main renal arteries (IR by 12%, IP by 16%). Under disease progression in IIIA stage there was: the growth of Vmax (21.5%), Vave (24.9%), Vmin (42.7%) on interlobular arteries; the decrease of Vave (24.8%), Vmin (51.5%) on interlobular renal arteries. The decrease of IR on interlobular arteries (9%) and its increase at the level of segmental and main renal arteries (11%) were diagnosed. The biggest changes in the blood flow by Dopplermetry data were diagnosed in MM patients at chronic renal disease (IІ and IIIB stages): the reduction of speed indicators on interlobular arteries – Vmax (26%), Vave (42%), Vmin (44%); on arc arteries – Vmax (29%), Vave (21%), Vmin (38%); on interlobar arteries – Vmax (30%), Vave (39%), Vmin (46%); on segmental arteries – Vmax (17%), Vave (22%), Vmin (42%); on the main renal artery – Vmax (11%), Vmin (33%). An increase in the indices of vascular resistance was revealed: IR on interlobular arteries (11%), the arc arteries (12%), interlobular arteries (11%), segmental arteries (13%), the main renal arteries (11%); IP on interlobular arteries (13%), the arc arteries (12%), interlobular arteries (13%), segmental arteries (12%), the main renal arteries (12%). These parameters correspond to Doppler criteria of chronic renal insufficiency of compensated stage.

Anatomical relationships between the renal segmental arteries and kidney collecting system of camel.

Anatomical relationships between the renal segmental arteries and kidney collecting system of camel.

A retrospective analysis of laparoscopic partial nephrectomy with segmental renal artery clamping and factors that predict postoperative renal function

To evaluate the feasibility and efficiency of laparoscopic partial nephrectomy (LPN) with segmental renal artery clamping, and to analyse the factors affecting postoperative renal function. We conducted a retrospective analysis of 466 consecutive patients undergoing LPN using main renal artery clamping (group A, n = 152) or segmental artery clamping (group B, n = 314) between September 2007 and July 2015 in our department. Blood loss, operating time, warm ischaemia time (WIT) and renal function were compared between groups. Univariable and multivariable linear regression analyses were applied to assess the correlations of selected variables with postoperative glomerular filtration rate (GFR) reduction. Volumetric data and estimated GFR of a subset of 60 patients in group B were compared with GFR to evaluate the correlation between these functional variables and preserved renal function after LPN. The novel technique slightly increased operating time, WIT and intra-operative blood loss (P < 0.001), while it provided better postoperative renal function (P < 0.001) compared with the conventional technique. The blocking method and tumour characteristics were independent factors affecting GFR reduction, while WIT was not an independent factor. Correlation analysis showed that estimated GFR presented better correlation with GFR compared with kidney volume (R(2) = 0.794 cf. R(2) = 0.199) in predicting renal function after LPN. LPN with segmental artery clamping minimizes warm ischaemia injury and provides better early postoperative renal function compared with clamping the main renal artery. Kidney volume has a significantly inferior role compared with eGFR in predicting preserved renal function.

Effect of selective segmental renal artery clamping on the liver

Objective To evaluate the effect of selective segmental renal artery clamping (SSRAC) on the liver so as to provide a foundation for the using of SSRAC in partial nephrectomy (PN). Methods A total of 18 domestic pigs were randomized equally into 2 groups according to the method of renal artery clamping such as main renal artery clamping (MRAC) and SSRAC. Each subject underwent radical nephrectomy to right kidney, and then either MRAC or SSRAC was performed to left kidney for 60 minutes. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured before surgery and at 6 time points thereafter (day 1, 7, 14, 21, 28, 90). Liver histology was observed on the first day and the 90th day after operation. Results On the first day after operation, ALT and AST values of the MRAC group were (79.00±9.30) U/L and (264.00±59.85) U/L, which was significantly higher than those of SSRAC group [(52.80±5.81) U/L and (143.20±29.22) U/L, P 0.05). In the MRAC group the liver experienced extensive hydropic degeneration, partial hepatic cells vacuolization and multifocal necrosis on the 1st day, and the above pathological changes were significantly attenuated on the 90th day. However, the liver pathological injury in SSRAC group was less at the two time points. Conclusion Compared with MRAC, SSRAC has a protective effect on liver postoperatively. It's better to choose SSRAC during PN. Key words: Selective renal artery clamping; Main renal artery clamping; Partial nephrectomy; Ischemia-reperfusion injury; Liver injury

Assessment of renal perfusion with contrast-enhanced ultrasound: Preliminary results in early diabetic nephropathies.

We performed a prospective study to evaluate the value of contrast-enhanced ultrasound (CEUS) in quantitative evaluation of renal cortex perfusion in patients suspected of early diabetic nephropathies (DN), with the estimated GFR (MDRD equation) as the gold standard. The study protocol was approved by the hospital review board; each patient gave written informed consent. Our study included 46 cases (21 males and 25 females, mean age 55.6 ± 4.14 years) of clinical confirmed early DN patients. After intravenous bolus injection of 1 ml sulfur hexafluoride microbubbles of ultrasound contrast agent, real time CEUS of renal cortex was performed successively using a 2-5 MHz convex probe. Time-intensity curves (TICs) and quantitative indexes were created with Qlab software. Receiver operating characteristic (ROC) curves were used to predict the diagnostic criteria of CEUS quantitative indexes, and their diagnostic efficiencies were compared with resistance index (RI) and peak systolic velocity (PSV) of renal segmental arteries by chi square test. Our control group included forty-five healthy volunteers. Difference was considered statistically significant with P < 0.05. Changes of area under curve (AUC), derived peak intensity (DPI) were statistically significant (P < 0.05). DPI less than 12 and AUC greater than 1400 had high utility in DN, with 71.7% and 67.3% sensitivity, 77.8% and 80.0% specificity. These results were significantly better than those obtained with RI and PSV which had no significant difference in early stage of DN (P > 0.05). CEUS might be helpful to improve early diagnosis of DN by quantitative analyses. AUC and DPI might be valuable quantitative indexes.

Traditional Thermal Therapy with Indirect Moxibustion Decreases Renal Arterial Resistive Index in Patients with Chronic Kidney Disease.

To evaluate the immediate effects of traditional local thermal therapy with indirect moxibustion on renal hemodynamics in patients with chronic kidney disease (CKD) by using Doppler ultrasonography (US). Examiner-blinded crossover study. Forty-three participants with CKD (mean age ± standard deviation [SD], 44 ± 15 years; estimated glomerular filtration rate, 69.5 ± 25.5 mL/min per 1.73 m(2); 20 men and 23 women). Participants received three successive treatment sessions of indirect moxibustion bilaterally at BL 23, a crucial acupuncture point, in the session. In the control session, the examiner was blinded by using smoke and aroma produced by moxibustion performed in an ashtray placed near the patient's body. The main outcome measure was resistive index (RI) in the renal segmental arteries. Blood flow parameters, including RI, were measured for six renal segmental arteries by using Doppler US at rest (baseline), immediately after completion of moxibustion (post 1), and 10 minutes later (post 2). Adverse events were monitored during intervention. In the control session, RI at post 1 (median [first, third quartile]: 0.587 [0.562, 0.626]) and post 2 (0.583 [0.567, 0.629]) did not change significantly compared with baseline (0.592 [0.563, 0.636]), while in the treatment session, RI at post 1 (0.565 [0.530, 0.618]) and post 2 (0.561 [0.533, 0.614]) decreased significantly compared with baseline (0.590 [0.550, 0.652]) (p < 0.001 and p < 0.001, respectively). The reduction in RI from baseline to post 2 in treatment session was significantly greater than in control session (mean ± SD, -0.026 ± 0.028 versus -0.003 ± 0.028; mean difference, -0.023 [95% confidence interval, -0.036 to -0.010]; p = 0.001]. No adverse events, such as burns, were observed during the study period. Renal vascular resistance was decreased after indirect moxibustion therapy in patients with CKD.

A model for assuring clamping success during laparoscopic partial nephrectomy with segmental renal artery clamping.

A model for assuring clamping success was established for laparoscopic partial nephrectomy (LPN) with segmental renal artery clamping (SRAC). Patients (n=107; December 2009-September 2011) who underwent LPN with SRAC dependent on the experience of the surgeon and CTA were retrospectively reviewed to determine the optimal characteristics of target arteries. After multiple logistic regression analysis, variables used to build a nomogram were selected using a backward elimination scheme. A model for a clamping program customized to the patient was designed. The surgical outcomes of patients (n=141; October 2011-June 2014) who subsequently underwent LPN-SRAC with the applied model were compared with those of the first group of patients. Five potential predictors were initially assessed: segmental renal artery angle, target artery diameter, and distance (d) to the abdominal aorta, renal hilum (d RH), and kidney midline (d KML). The regression equation was set up as: [Formula: see text]Comparing the patient groups, those for whom the new SRAC model was applied had a significantly better success rate of clamping (P<0.001), less total operative time (P<0.001), and less operative blood loss (P=0.042). No obvious differences were observed in time of warm ischemia, postoperative hospitalization, RENAL nephrometry score, or number of final clamped branches. The model for assuring clamping success was helpful in designing an SRAC program and thus benefiting the LPN procedure.

The study of selective segmental renal artery clamping aggravating pathological injury of the solitary-kidney in a porcine model

Objective To evaluate the effect of selective segmental renal artery clamping (SSRAC) on the solitary-kidney, providing a foundamental basis for the using of SSRAC in partial nephrectomy. Methods A total of 18 pigs were randomized equally into 2 groups according to the method of renal artery clamping such as main renal artery clamping (MRAC) group or SSRAC group. Each case underwent right radical nephrectomy and either MRAC or SSRAC for 60 minutes on the left kidney. Serum creatinine (SCr) and blood urea nitrogen (BUN) were measured before surgery and at 6 time points thereafter (the 1st, 7th, 14th, 21st, 28th, 90th day). Magnetic resonance imaging was performed before surgery and at 4 time points thereafter (the 1st, 7th, 28th, 90th day) and T2 relaxation time and apparent diffusion coefficient (ADC) were determined. Inflammatory cell infiltration and interstitial fibrosis were detected using renal histology on the 1st and 90th day after operation. Results SCr and BUN of the two groups increased to peak value on the 1st day, and then decreased gradually to normal on the 90th day after the operation. On the 1st day, SCr [(266.43±31.12)umol/l] and BUN [(13.63±2.54)mmol/l)] of SSRAC group were significantly lower than that of MRAC [(386.37±40.40)umol/l, (26.83±5.96)mmol/l] (P 0.05) on the 7th, 14th, 21st, 28th, 90th day. In the MRAC group, the T2 relaxation time of upper, middle and lower pole of the left kidney increased and the ADC decreased on the 1st day after operation. It arrived to the peak value on the 7th day, and decreased or increased respectively from then on to normal level on the 90th day. In the SSRAC group, there were no significant changes of T2 relaxation time and ADC in the upper and middle pole of left kidney (P>0.05), but it was similar to that in the MRAC group for lower pole. On the 1st, 7th, 28th day after operation, the T2 relaxation time of upper and middle pole of the left kidney in the MRAC group [(45.50±1.87), (51.82±2.27), and(40.37±1.93)ms ) ] were significantly higher than those in the SSRAC group [(36.67±1.33), (35.15±1.27), and(37.48±1.37)ms](P 0.05). On the 1st, 7th, 28th day after operation, the ADC of upper and middle pole of the left kidney in the MRAC group [(2.29±0.08)×10-3mm2/s, (2.10±0.08) ×10-3mm2/s, (2.41±0.09)×10-3mm2/s] were significantly lower than that of the SSRAC group [(2.69±0.08)×10-3mm2/s, (2.63±0.06)×10-3mm2/s, (2.68±0.05)×10-3mm2/s](P<0.05). However, on the 1st, 7th, 28th, 90th day after operation, the ADC of lower pole of the left kidney in the SSRAC group [(1.93±0.08)×10-3mm2/s, (1.91±0.09)×10-3mm2/s, (2.33±0.07)×10-3mm2/s, and (2.43±0.07)×10-3mm2/s] were significantly lower than those of the MRAC group [(2.37±0.05)×10-3mm2/s, (2.06±0.07)×10-3mm2/s, (2.46±0.09)×10-3mm2/s, (2.61±0.08)×10-3mm2/s](P<0.05). The whole left kidney in MRAC group experienced extensive tubular hydropic degeneration and limited inflammatory cell infiltration on the 1st day after operation. Moreover, renal tubular hydropic degeneration alleviated and no glomerular changes, fibrous tissue hyperplasia or inflammatory cell infiltration was found on the 90th day after operation. In SSRAC group, no changes were found in upper and middle pole of left kidney at the two time points, while the pathological injury of the lower pole of left kidney was more severe. Conclusions SSRAC has obvious protective effect on renal function in the early stage. However, compared with MRAC, the renal tissue injury in the ischemic area was more serious. Therefore, to protect renal function in partial nephrectomy, the ischemic renal area should be reduced as much as possible, even to zero-ischemic, when adopting SSRAC. Key words: Selective segmental renal artery clamping; Ischemia-reperfusion injury; T2 relaxation time; Apparent diffusion coefficient; Renal function