Infrarenal aortic-clamping after renal ischaemia aggravates acute renal failure

Eur J Clin Invest 2011; 41 (6): 605–615 Abstract Background Renal failure is a frequent complication of juxtarenal abdominal aortic aneurysm (JAA)-repair. During this operation, suprarenal aortic-clamping is followed by infrarenal aortic-clamping (below renal arteries) to restore renal flow, while performing the distal anastomosis. We hypothesized that infrarenal aortic-clamping, despite restoring renal perfusion provokes additional renal damage. Materials and methods We studied three groups of rats. After 45 min of suprarenal aortic-clamping, group 1 had renal reperfusion for 90 min without aortic-clamps (n = 7). In group 2, 45 min of suprarenal aortic-clamping with a distal clamp on the aortic-bifurcation was followed by 20 min of infrarenal aortic-clamping. Renal reperfusion was continued for 70 min without aortic-clamps (i.e. 90 min of renal reperfusion; n = 8). The sham-group had no clamps (n = 7). We measured renal haemodynamics, functional parameters and tissue damage. Results On suprarenal aortic-clamp removal, renal artery flow, cortical flow and arterial pressures were higher in group 2 than in group 1. We detected increased tubular brush border damage, luminal lipocalin-2 and 30–60% higher renal protein nitrosylation in group 2 when compared to group 1 (P