Renal Decapsulation Prevents Intrinsic Renal Compartment Syndrome in Ischemia-Reperfusion–Induced Acute Kidney Injury: A Physiologic Approach

Objectives: Acute kidney injury is a serious complication with unacceptably high mortality that lacks of specific curative treatment. Therapies focusing on the hydraulic behavior have shown promising results in preventing structural and functional renal impairment, but the underlying mechanisms remain understudied. Our goal is to assess the effects of renal decapsulation on regional hemodynamics, oxygenation, and perfusion in an ischemic acute kidney injury experimental model. Methods: In piglets, intra renal pressure, renal tissue oxygen pressure, and dysoxia markers were measured in an ischemia-reperfusion group with intact kidney, an ischemia-reperfusion group where the kidney capsule was removed, and in a sham group. Results: Decapsulated kidneys displayed an effective reduction of intra renal pressure, an increment of renal tissue oxygen pressure, and a better performance in the regional delivery, consumption, and extraction of oxygen after reperfusion, resulting in a marked attenuation of acute kidney injury progression due to reduced structural damage and improved renal function. Conclusions: Our results strongly suggest that renal decapsulation prevents the onset of an intrinsic renal compartment syndrome after ischemic acute kidney injury. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/29S62lw). Drs. Cruces, Salas, and F. Lillo received support for article research from the Sociedad Chilena de Pediatria. The remaining authors have disclosed that they do not have any potential conflicts of interest. Supported, in part, by the Fondecyt Regular number 1160631 grant of the Fondo Nacional de Desarrollo Científico y Tecnológico, the Proyecto en Ciencias Biomédicas y Clínicas 2015 Universidad Andrés Bello (DI-749-15/CB), and by funding from the Sociedad Chilena de Pediatría 2012001 Grant. For information regarding this article, E-mail: dhurtado@ing.puc.cl Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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