Renal artery embolization post subtotal nephrectomy for xanthogranulomatous pyelonephritis: A case report

Xanthogranulomatous pyelonephritis (XGPN) is a rare, chronic disease characterized by the destruction of renal parenchyma and replacement with granulomatous tissue and is associated with long-term obstructive uropathy, chronic renal parenchymal infection, and nephrolithiasis. A 57-year-old patient with XGPN was unable to undergo total nephrectomy. Renal artery embolization (RAE) was performed post subtotal nephrectomy as adjunct therapy to prevent urine formation and decrease the risk of post-operative infection. Our case report demonstrates that RAE can be performed safely and effectively without evident complications and underscores the utility of cone-beam computed tomography in cases of altered post-surgical anatomy. To the author’s knowledge, this is the second case in the literature demonstrating perioperative management of XGPN with RAE.

Metformin arrests the progression of established kidney disease in the subtotal nephrectomy model of chronic kidney disease

Metformin, an AMP-activated protein kinase (AMPK) activator, has been shown in previous studies to reduce kidney fibrosis in different models of experimental chronic kidney disease (CKD). However, in all of these studies, the administration of metformin was initiated before the establishment of renal disease, which is a condition that does not typically occur in clinical settings. The aim of the present study was to investigate whether the administration of metformin could arrest the progression of established renal disease in a well-recognized model of CKD, the subtotal kidney nephrectomy (Nx) model. Adult male Munich-Wistar rats underwent either Nx or sham operations. After the surgery (30 days), Nx rats that had systolic blood pressures of >170 mmHg and albuminuria levels of >40 mg/24 h were randomized to a no-treatment condition or to a treatment condition with metformin (300 mg·kg−1·day−1) for a period of either 60 or 120 days. After 60 days of treatment, we did not observe any differences in kidney disease parameters between Nx metformin-treated and untreated rats. However, after 120 days, Nx rats that had been treated with metformin displayed significant reductions in albuminuria levels and in markers of renal fibrosis. These effects were independent of any other effects on blood pressure or glycemia. In addition, treatment with metformin was also able to activate kidney AMPK and therefore improve mitochondrial biogenesis. It was concluded that metformin can arrest the progression of established kidney disease in the Nx model, likely via the activation of AMPK.

The protective effect of celery (Apium graveolens L.) ethanol extract on anemia in 5/6 subtotal nephrectomy rat model

Background<br />Anemia is a frequent complication of chronic kidney disease (CKD). Anemia in CKD is associated with reduced quality of life, increased cardiovascular disease, cognitive impairment, and mortality. Therefore it is necessary to find an alternative agent for preventing anemia in CKD. Celery is one of the natural substances that have anti-inflammatory, antioxidant, and antihypertensive pharmacological effects. Based on the mechanism of CKD and its progression, celery is thought to prevent anemia in CKD. This research was aimed at evaluating the protective effect of celery extract against anemia in a CKD rat model. <br /><br />Methods<br />This was an experimental laboratory study using 25 male Sprague Dawley rats, aged 2-3 months, they were randomized into 5 groups, namely group A, sham operation; group B, subtotal nephrectomy; group C, D, E, subtotal nephrectomy + 250, 500, 1000 mg/kg BW ethanol extract of celery, respectively. The administration of celery extract was performed 14 days before and 14 days after induction of 5/6 subtotal nephrectomy. The hematological parameters (Hb, RBC, Ht, MCV, MCH, MCHC) and serum creatinine level were measured at the end of the study. Data were analyzed with One Way ANOVA and Kruskal-Wallis test followed by Mann-Whitney test at p&lt;0.05. <br /><br />Results<br />There were no significant differences between groups in Hb, RBC, Ht, MCV (p&gt;0.05) and significant differences between groups in MCH and MCHC (p&lt;0.05). The highest levels of Hb, RBC, and Ht were found in group C.<br /><br />Conclusion<br />Celery ethanol extract at a dose of 250 mg/kg BW/day may prevent anemia in the CKD rat model.

EFFECT OF SIMVASTATIN ON HISTOPATHOLOGY OF THE HEART AFTER 5/6 SUBTOTAL NEPHRECTOMY

Objective: This study aims to assess the condition of cardiac histopathology through hematoxylin-eosin staining in 5/6 subtotal nephrectomyconditions.Methods: Fifteen male Swiss mice aged 3–5 months will be grouped into 3 treatment groups, namely the nephrectomy group (JSN, n=5), shamoperation (JSO, n=5), and simvastatin 20 mg/kg body weight (JSIM, n=5). The histopathology of the heart will be assessed blindly. Severity is assessedbased on scoring using a scale (−) no damage, (+) mild, (++) medium, and (+++) heavy. Assessment of severity refers to the irregularity of the heartmuscle, increased amount of connective tissue, myofibril hypertrophy, myofibril swelling, sarcoplasmic fragmentation, sarcoplasmic vacuolization,bleeding in a myofibril, myofibril degeneration, cardiomyocyte damage, and the presence of acidophilic cytoplasm.Results: The results showed no morphological changes in heart muscle tissue in the JSO group except for fragmentation and vacuolization in minimalamounts of sarcoplasm (+), whereas in the JSN and JSIM groups, there was moderate damage to sarcoplasm (++) and minimal changes in myofibrils(hypertrophy and bleeding) (+). The JSN group also found severe damage (+++) to the irregularity of the heart muscle, whereas in JSIM, only moderatedamage was found (++) to the irregularity of the heart muscle.Conclusion: Simvastatin seems to be able to correct the irregularity of the heart muscle in the condition of 5/6 subtotal nephrectomy.

Nitric oxide mediates anomalous tubuloglomerular feedback in rats fed high-NaCl diet after subtotal nephrectomy

Tubuloglomerular feedback (TGF) responses become anomalous in rats fed high-NaCl diet after subtotal nephrectomy (STN), such that stimulating TGF causes single nephron GFR (SNGFR) to increase rather than decrease. Micropuncture experiments were performed to determine whether this anomaly results from heightened nitric oxide response to distal delivery, which is a known mechanism for resetting TGF, or from connecting tubule TGF (cTGF), which is a novel amiloride-inhibitable system for offsetting TGF responses. Micropuncture was done in Wistar Froemter rats fed high-NaCl diet (HS) for 8–10 days after STN or sham nephrectomy. TGF was manipulated by orthograde microperfusion of Henle’s loop with artificial tubular fluid with or without NOS inhibitor, LNMMA, or the cell-impermeant amiloride analog, benzamil. SNGFR was measured by inulin clearance in tubular fluid collections from the late proximal tubule. TGF responses were quantified as the increase in SNGFR that occurred when the perfusion rate was reduced from 50 to 8 nl/min in STN or 40 to 8 nl/min in sham animals. The baseline TGF response was anomalous in STN HS (−4 ± 3 vs 14 ± 3 nl/min, P < 0.001). TGF response was normalized by perfusing STN nephron with LNMMA (14 ± 3 nl/min, P < 0.005 for ANOVA cross term) but not with benzamil (−3 ± 4 nl/min, P = 0.4 for ANOVA cross term). Anomalous TGF occurs in STN HS due to heightened effect of tubular flow on nitric oxide signaling, which increases to the point of overriding the normal TGF response. There is no role for cTGF in this phenomenon.