Ancillary Techniques For Ischemic Renoprotection

The cornerstones of minimizing renal ischemic damage are to achieve copious diuresis before and after hilar clamping, reduce oxidative damage due to free radicals and minimize ischemia time during surgery. Intravenous mannitol given 10-15 minutes prior to and immediately after arterial occlusion ensures adequate diuresis after unclamping.

Protection of renal function by injection of the nucleotide inosine has been well documented in literature. Wickham et al. in 1979 reported the use of inosine in seven bNycomed, Linz, Austria.

patients. Six of these had a staghorn calculus and one had a renal tumor. Ten minutes prior to clamping, 2 g of inosine in 80 mL of diluent Trophycardylc were administered intravenously. The renal artery was then occluded and surgery performed. On differential renography postoperatively patients showed evidence of diminished function, but by one month all had regained preoperative function. Inosine is thought to act by replenishing the adenylic nucleotide pool.

Oxygen free radicals generated as a result of anaerobic metabolism are known to have a toxic effect on cellular architecture. Scavengers of oxygen free radicals may have a renoprotective effect in patients requiring extensive ischemic periods for complicated reconstructive surgeries.

0 0

Post a comment