Percutaneous Renal Access

Surgical Factors Involved in the Acute Reduction of Renal Function

Rajash Handa, Cynthia D. Johnson, Bret A. Connors, Andrew Evan, James E. Lingeman, Ziyue Liu

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction and Objective: Studies in patients and experimental animals have shown that percutaneous nephrolithotomy (PCNL) can acutely impair glomerular filtration and renal perfusion, but the factors contributing to this decline in renal function are unknown. The present study assessed the contribution of needle puncture of the kidney vs dilation of the needle tract to the acute decline in renal hemodynamic and tubular transport function associated with PCNL surgery. Materials and Methods: Acute experiments were performed in three groups of anesthetized adult farm pigs: sham-percutaneous access (PERC), that is, no surgical procedure (n = 7); a single-needle stick to access the renal collecting system (n = 8); expansion of the single-needle access tract with a 30F NephroMax balloon dilator and insertion of a nephrostomy sheath (n = 10). The glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and renal extraction of para-amino hippurate (EPAH, estimates tubular organic anion transporter [OAT] activity) were assessed before and 1 to 4.5 hours after sham-PERC or PERC surgical procedures. Results: Overall, GFR responses were similar in all three groups. Sham-treated PERC pigs showed no significant change in ERPF over the experimental observation period, whereas a single-needle stick to access the renal collecting system resulted in renal vasoconstriction (∼30% reduction in ERPF, p <0.05). Dilation of the single-needle access tract to create the nephrostomy did not lead to a further decline in ERPF. PERC surgical procedure-mediated renal vasoconstriction was most evident at the 1-hour posttreatment time point. A reduction in EPAH was only observed in pig kidneys with a nephrostomy. Conclusions: Needle puncture of the kidney for percutaneous access to the renal collecting system is the major driving force for the renal vasoconstriction observed after PCNL surgery, whereas creation of the nephrostomy appears to be largely responsible for decreasing tubular OAT activity.

Original languageEnglish (US)
Pages (from-to)178-183
Number of pages6
JournalJournal of Endourology
Volume30
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Kidney
Effective Renal Plasma Flow
Needles
Percutaneous Nephrostomy
Vasoconstriction
Organic Anion Transporters
Needlestick Injuries
Swine
Glomerular Filtration Rate
Punctures
Dilatation
Perfusion
Hemodynamics
Observation

ASJC Scopus subject areas

  • Urology

Cite this

Percutaneous Renal Access : Surgical Factors Involved in the Acute Reduction of Renal Function. / Handa, Rajash; Johnson, Cynthia D.; Connors, Bret A.; Evan, Andrew; Lingeman, James E.; Liu, Ziyue.

In: Journal of Endourology, Vol. 30, No. 2, 01.02.2016, p. 178-183.

Research output: Contribution to journalArticle

Handa, Rajash ; Johnson, Cynthia D. ; Connors, Bret A. ; Evan, Andrew ; Lingeman, James E. ; Liu, Ziyue. / Percutaneous Renal Access : Surgical Factors Involved in the Acute Reduction of Renal Function. In: Journal of Endourology. 2016 ; Vol. 30, No. 2. pp. 178-183.
@article{e8e11d9799da4a5897eb95a2b757c9bc,
title = "Percutaneous Renal Access: Surgical Factors Involved in the Acute Reduction of Renal Function",
abstract = "Introduction and Objective: Studies in patients and experimental animals have shown that percutaneous nephrolithotomy (PCNL) can acutely impair glomerular filtration and renal perfusion, but the factors contributing to this decline in renal function are unknown. The present study assessed the contribution of needle puncture of the kidney vs dilation of the needle tract to the acute decline in renal hemodynamic and tubular transport function associated with PCNL surgery. Materials and Methods: Acute experiments were performed in three groups of anesthetized adult farm pigs: sham-percutaneous access (PERC), that is, no surgical procedure (n = 7); a single-needle stick to access the renal collecting system (n = 8); expansion of the single-needle access tract with a 30F NephroMax balloon dilator and insertion of a nephrostomy sheath (n = 10). The glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and renal extraction of para-amino hippurate (EPAH, estimates tubular organic anion transporter [OAT] activity) were assessed before and 1 to 4.5 hours after sham-PERC or PERC surgical procedures. Results: Overall, GFR responses were similar in all three groups. Sham-treated PERC pigs showed no significant change in ERPF over the experimental observation period, whereas a single-needle stick to access the renal collecting system resulted in renal vasoconstriction (∼30{\%} reduction in ERPF, p <0.05). Dilation of the single-needle access tract to create the nephrostomy did not lead to a further decline in ERPF. PERC surgical procedure-mediated renal vasoconstriction was most evident at the 1-hour posttreatment time point. A reduction in EPAH was only observed in pig kidneys with a nephrostomy. Conclusions: Needle puncture of the kidney for percutaneous access to the renal collecting system is the major driving force for the renal vasoconstriction observed after PCNL surgery, whereas creation of the nephrostomy appears to be largely responsible for decreasing tubular OAT activity.",
author = "Rajash Handa and Johnson, {Cynthia D.} and Connors, {Bret A.} and Andrew Evan and Lingeman, {James E.} and Ziyue Liu",
year = "2016",
month = "2",
day = "1",
doi = "10.1089/end.2015.0542",
language = "English (US)",
volume = "30",
pages = "178--183",
journal = "Journal of Endourology",
issn = "0892-7790",
publisher = "Mary Ann Liebert Inc.",
number = "2",

}

TY - JOUR

T1 - Percutaneous Renal Access

T2 - Surgical Factors Involved in the Acute Reduction of Renal Function

AU - Handa, Rajash

AU - Johnson, Cynthia D.

AU - Connors, Bret A.

AU - Evan, Andrew

AU - Lingeman, James E.

AU - Liu, Ziyue

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Introduction and Objective: Studies in patients and experimental animals have shown that percutaneous nephrolithotomy (PCNL) can acutely impair glomerular filtration and renal perfusion, but the factors contributing to this decline in renal function are unknown. The present study assessed the contribution of needle puncture of the kidney vs dilation of the needle tract to the acute decline in renal hemodynamic and tubular transport function associated with PCNL surgery. Materials and Methods: Acute experiments were performed in three groups of anesthetized adult farm pigs: sham-percutaneous access (PERC), that is, no surgical procedure (n = 7); a single-needle stick to access the renal collecting system (n = 8); expansion of the single-needle access tract with a 30F NephroMax balloon dilator and insertion of a nephrostomy sheath (n = 10). The glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and renal extraction of para-amino hippurate (EPAH, estimates tubular organic anion transporter [OAT] activity) were assessed before and 1 to 4.5 hours after sham-PERC or PERC surgical procedures. Results: Overall, GFR responses were similar in all three groups. Sham-treated PERC pigs showed no significant change in ERPF over the experimental observation period, whereas a single-needle stick to access the renal collecting system resulted in renal vasoconstriction (∼30% reduction in ERPF, p <0.05). Dilation of the single-needle access tract to create the nephrostomy did not lead to a further decline in ERPF. PERC surgical procedure-mediated renal vasoconstriction was most evident at the 1-hour posttreatment time point. A reduction in EPAH was only observed in pig kidneys with a nephrostomy. Conclusions: Needle puncture of the kidney for percutaneous access to the renal collecting system is the major driving force for the renal vasoconstriction observed after PCNL surgery, whereas creation of the nephrostomy appears to be largely responsible for decreasing tubular OAT activity.

AB - Introduction and Objective: Studies in patients and experimental animals have shown that percutaneous nephrolithotomy (PCNL) can acutely impair glomerular filtration and renal perfusion, but the factors contributing to this decline in renal function are unknown. The present study assessed the contribution of needle puncture of the kidney vs dilation of the needle tract to the acute decline in renal hemodynamic and tubular transport function associated with PCNL surgery. Materials and Methods: Acute experiments were performed in three groups of anesthetized adult farm pigs: sham-percutaneous access (PERC), that is, no surgical procedure (n = 7); a single-needle stick to access the renal collecting system (n = 8); expansion of the single-needle access tract with a 30F NephroMax balloon dilator and insertion of a nephrostomy sheath (n = 10). The glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and renal extraction of para-amino hippurate (EPAH, estimates tubular organic anion transporter [OAT] activity) were assessed before and 1 to 4.5 hours after sham-PERC or PERC surgical procedures. Results: Overall, GFR responses were similar in all three groups. Sham-treated PERC pigs showed no significant change in ERPF over the experimental observation period, whereas a single-needle stick to access the renal collecting system resulted in renal vasoconstriction (∼30% reduction in ERPF, p <0.05). Dilation of the single-needle access tract to create the nephrostomy did not lead to a further decline in ERPF. PERC surgical procedure-mediated renal vasoconstriction was most evident at the 1-hour posttreatment time point. A reduction in EPAH was only observed in pig kidneys with a nephrostomy. Conclusions: Needle puncture of the kidney for percutaneous access to the renal collecting system is the major driving force for the renal vasoconstriction observed after PCNL surgery, whereas creation of the nephrostomy appears to be largely responsible for decreasing tubular OAT activity.

UR - http://www.scopus.com/inward/record.url?scp=84958181079&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958181079&partnerID=8YFLogxK

U2 - 10.1089/end.2015.0542

DO - 10.1089/end.2015.0542

M3 - Article

VL - 30

SP - 178

EP - 183

JO - Journal of Endourology

JF - Journal of Endourology

SN - 0892-7790

IS - 2

ER -