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      Theoretical mechanism of temporary renal function improvement after abdominal aortic aneurysm surgery : Applications for clinical imaging and laboratory data

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          Abstract

          We evaluated the effects of changes in blood flow due to abdominal aortic aneurysm (AAA) surgery by using a simple zero-dimension model and applied theoretical values to clinical data.

          The zero-dimension electronic circuit model and diagram of blood flow distribution were created by setting the resistance of the aorta, bilateral iliac arteries, renal arteries, and aneurysm. Resistance of the aneurysm and resistance of the aorta before surgery were compared with that of the aorta after surgery. We set the radius length of each anatomical parameter to calculate theoretical values.

          Renal flow increased 13.4% after surgery. Next, we analyzed contrast-enhanced computed tomography data of 59 patients who underwent AAA surgery. A total of 19 patients were treated with a Y graft and 7 patients were treated with a straight graft during open surgery. However, 33 patients were treated with a bifurcated stent graft. A significant linear relationship between the increased estimated glomerular filtration rate (eGFR) ratio and the decreased aneurysm ratio was found only for the straight graft group.

          Using a circuit model, renal blood flow theoretically increased after AAA surgery. Clinically, there was a correlation between volume regression and eGFR improvement only in the limited AAA group.

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          Long-term risk of mortality and acute kidney injury during hospitalization after major surgery.

          Douglas Hobson, Jesse Schold, Balaaji S. P. Subbiah … (2009)
          To determine the relationship between long-term mortality and acute kidney injury (AKI) during hospitalization after major surgery. AKI is associated with a risk of short-term mortality that is proportional to its severity; however the long-term survival of patients with AKI is poorly studied. This is a retrospective cohort study of 10,518 patients with no history of chronic kidney disease who were discharged after a major surgery between 1992 and 2002. AKI was defined by the RIFLE (Risk, Injury, Failure, Loss, and End-stage Kidney) classification, which requires at least a 50% increase in serum creatinine (sCr) and stratifies patients into 3 severity stages: risk, injury, and failure. Patient survival was determined through the National Social Security Death Index. Long-term survival was analyzed using a risk-adjusted Cox proportional hazards regression model. In the risk-adjusted model, survival was worse among patients with AKI and was proportional to its severity with an adjusted hazard ratio of 1.18 (95% confidence interval [CI], 1.08-1.29) for the RIFLE-Risk class and 1.57 (95% CI, 1.40-1.75) for the RIFLE-Failure class, compared with patients without AKI (P < 0.001). Patients with complete renal recovery after AKI still had an increased adjusted hazard ratio for death of 1.20 (95% CI, 1.10-1.31) compared with patients without AKI (P < 0.001). In a large single-center cohort of patients discharged after major surgery, AKI with even small changes in sCr level during hospitalization was associated with an independent long-term risk of death.
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            Technical factors are strongest predictors of postoperative renal dysfunction after open transperitoneal juxtarenal abdominal aortic aneurysm repair.

            Luc Dubois, Craig Durant, David Harrington … (2013)
            Juxtarenal abdominal aortic aneurysms (AAAs) have predominantly been repaired using an open technique. We present a series of patients with juxtarenal AAAs and analyze multiple factors predictive of postoperative renal dysfunction.
            Article 0 comments Cited 12 times – based on 0 reviews     Review now
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              Renal hemodynamics, function, and oxygenation during cardiac surgery performed on cardiopulmonary bypass: a modeling study

              Ioannis Sgouralis, Roger G. Evans, Bruce S. Gardiner … (2015)
              Abstract Acute kidney injury, a prevalent complication of cardiac surgery performed on cardiopulmonary bypass (CPB), is thought to be driven partly by hypoxic damage in the renal medulla. To determine the causes of medullary hypoxia during CPB, we modeled its impact on renal hemodynamics and function, and thus oxygen delivery and consumption in the renal medulla. The model incorporates autoregulation of renal blood flow and glomerular filtration rate and the utilization of oxygen for tubular transport. The model predicts that renal medullary oxygen delivery and consumption are reduced by a similar magnitude during the hypothermic (down to 28°C) phase of CPB. Thus, the fractional extraction of oxygen in the medulla, an index of hypoxia, is increased only by 58% from baseline. However, during the rewarming phase (up to 37°C), oxygen consumption by the medullary thick ascending limb increases 2.3‐fold but medullary oxygen delivery increases only by 33%. Consequently, the fractional extraction of oxygen in the medulla is increased 2.7‐fold from baseline. Thus, the renal medulla is particularly susceptible to hypoxia during the rewarming phase of CPB. Furthermore, autoregulation of both renal blood flow and glomerular filtration rate is blunted during CPB by the combined effects of hemodilution and nonpulsatile blood flow. Thus, renal hypoxia can be markedly exacerbated if arterial pressure falls below its target level of 50 mmHg. Our findings suggest that tight control of arterial pressure, and thus renal oxygen delivery, may be critical in the prevention of acute kidney injury associated with cardiac surgery performed on CPB.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: July 2017
                Publication date (Electronic): 28 July 2017
                Volume: 96
                Issue: 30
                Electronic Location Identifier: e7428
                Affiliations
                [a ]Department of Vascular Surgery
                [b ]Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo
                [c ]Department of Mechanical Engineering, Graduate School, Shibaura Institute of Technology, Tokyo, Japan.
                Author notes
                [∗ ]Correspondence: Katsuyuki Hoshina, Department of Vascular Surgery, The University of Tokyo Hospital, Tokyo, Japan (e-mail: traruba@ 123456gmail.com ).
                Article
                Publisher ID: MD-D-17-01956 Accession ID: 07428
                DOI: 10.1097/MD.0000000000007428
                PMC ID: 5627810
                PubMed ID: 28746184
                SO-VID: b3ec170a-13fb-43a1-93ca-2a7e80380a6a
                Copyright © Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-nc-sa/4.0

                History
                Date received : 30 March 2017
                Date revision received : 4 June 2017
                Date accepted : 10 June 2017
                Categories
                Subject: 3400
                Subject: Research Article
                Subject: Observational Study
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: abdominal aortic aneurysm,electric model,improvement,renal function,simulation
                Data availability:
                Keywords: abdominal aortic aneurysm, electric model, improvement, renal function, simulation

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