Renal vascular injury

The diagnosis of renovascular injury may be difficult in some patients, especially because hematuria, which is thought to be present in most patients, can be absent in up to 33% of patients with injuries to the renal artery [82]. This is why imaging is often necessary in these patients. In addition, patients with renal vascular injuries typically have other significant intraperitoneal and retroperitoneal injury [83], supporting the need for imaging evaluation. These other injuries can lead to the elevated injury severity scores and increased transfusion requirements often seen in these patients [83]. 

There are potential complications associated with the surgical management of patients with renal vascular injuries. These include azotemia and persistent hypertension, which may possibly require nephrectomy for management [83, 98, 99]. At the present time, significant and persistent hypertension has... 

Chatziioannou A, Brountzos E, Primetis E, Malagari K, Sofo-cleous C, Mourikis D et al. (2004) Effects of superselective embolization for renal vascular injuries on renal parenchyma and function. Eur J Vase Endovasc Surg 28 201-206... 

The FVB-T1E2/GFP mouse, in which the endothelium is fluorescent, has heen used to study morphological changes in the renal microvascular endothelium during ischemia-reperfusion injury in the kidney [169]. Alterations in the cytoskeleton of renal microvascular endothelial cells correlated with a permeability defect in the renal microvasculature as identified using fluorescent dextrans and two-photon intravital imaging. This study demonstrates that renal vascular endothelial injury occurs in ischemic AKI and may play an important role in the pathophysiology of ischemic AKI. 

The IPRK was used to demonstrate that excess nitric oxide (NO) and possibly endothelium-derived hyperpolarizing factor (EDHF), contribute to impaired autoregulation after ischemic injury as described above [328]. A role for EDHF in renal vascular resistance and in glomerular and tubular function was first observed in the IPRK by Bhardwaj and Moore [386] and by Rademacher et al [387-8]. Others observed that manipulating NO can alter medullary oxygenation in the IPRK [288]. An increased endothelium-dependent vasodilator response to acetylcholine was observed in IPRK from cirrhotic rats [390]. Portal vein ligation also... 

Yasuda H, Yuen PS, Hu X, Zhou H, Star RA Simvastatin improves sepsis-induced mortality and acute kidney injury via renal vascular effects. Kidney International 69 1535-1542, 2006... 

Studies of the pathophysiology of acute renal failure has classically considered both tubular and vascular mechanisms [227,228]. In vitro techniques isolating either the vascular or tubular components have been developed. For example, the use of isolated proximal tubules in suspension or in culture allows the study of tubular mechanisms of injury in the absence of vascular factors [229] [230]. There are both in vitro and in vivo models to study vascular injury in the kidney. In vitro models include the study of vascular smooth muscle cells or endothelial cells in culture. In this section, the in vivo methods to evaluate the renal micro-circulation will be discussed. This is of relevance as many nephrotoxins exert their deleterious effects through pharmacologic actions on the resistance vasculature with parenchymal injury occurring as a consequence of ischemia. In clinical practice nephrotoxins may cause prerenal azotemia as a result of increased renal vascular resistance. Nephrotoxins that cause acute renal failure on a vascular basis include prostaglandin inhibitors e.g. aspirin, non-steroidal anti-... 

Somewhere in the mosaic of atherosclerosis, vascular sensitivity and reaction resembling an allergic response may occur. Hypertension of renal origin may be paralleled by the contribution of some component by the kidney (or by some sources excited by the hypertension or Injured kidney) that causes a predisposition of the arterial wall toward atherosclerosis. Vascular Injury of the "serum sickness" type from vascular... 

Vascular Injury to main renal artery or vein with contained Hemorrhage Laceration Completely shattered kidney, ureteropelviceal avulsion Vascular Avulsion of renal hilum, devascularizing kidney... 

Technical success of embolization for intrarenal vascular injury is quite high, around 95-100% [42-44]. Typically the recurrence rate is nearly 0% however, in one series a second embolization session was needed in 2 (15%) of 13 patients to fully occlude arteriovenous fistulas and achieve true technical success [44]. An analysis of the effect on renal function of selective embolization for traumatic renal lesions revealed that the mean volume of infarcted kidney was only 6% (range 0-15%) and 1 week postembolization the serum creatinine was normal in all their patients [42]. A series of renal transplants estimated that the maximal volume of infarcted kidney after embolization for biopsy-related injuries was always less than 30% [44]. Also, while renal function dete-... 

Maleux G, Messiaen T, Stocks L,VanrenterghemY, Wihns G (2003) Transcatheter embolization of biopsy-related vascular injuries in renal allografts. Long-term technical, clinical and biochemical results. Acta Radiol 44 13-17... 

Williams et al. (1997) described renal ischemia-reperfusion injury in rats. The animals were anesthetized and subjected to 45min of bilateral renal occlusion using atraumatic vascular clamps before renal perfusion was reestablished. After various time interval (up to lweek) blood urea nitrogen, creatinine and myeloperoxidase activity in the kidney were determined. The protective effects of an intracellular adhesion molecule monoclonal antibody were tested. 

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