Pedículo Renal: Análisis de sus Variantes / Renal Pedicle: Analysis of their Variants

Testut & Latarjet (1980), Bouchet & Cuilleret (1986), Latarjet & Liard (2005) y Rouvière & Delmas (2005) describen las relaciones intrínsecas del pedículo renal (PR) a partir de dos planos coronales, siendo la PER el elemento que limita entre ambos. Trivedi et al. (2011) demostró relaciones entre los elementos del PR que no coinciden con las descripciones aportadas por dichos autores.Conocer las posibles variantes en las relaciones intrínsecas del PR es de suma importancia en prácticas quirúrgicas como el trasplante renal (García de Jalón Martínez et al., 2003; Batista Hernández et al., 2010). Por lo tanto, el objetivo del presente trabajo fue analizar las variables relaciones entre los elementos que conforman el PR en la región yuxtahiliar del riñón. Se estudiaron 23 PR, formolizados al 10 % y provistos por el Equipo de Disección de la Segunda Cátedra de Anatomía de la Universidad de Buenos Aires. Se clasificaron los PR en dos grupos. En el Grupo I, las afluentes de origen de la vena renal (AOVR) se hallaban en el mismo plano coronal. En el grupo II, las AOVR se encontraban en diferentes planos coronales. Cada grupo fue subdividido en distintos patrones. Los patrones I y II, de mayor incidencia, fueron asociados al grupo I y los patrones III, IV y V al grupo II. En el patrón I, las AOVR eran anteriores a la pelvis renal (PER) y posteriores a la arteria prepiélica (APP). En el patrón II, las AOVR eran anteriores a la PER y a la APP. Los patrones I y II conforman el grupo I y presentaron mayor número de incidencia en nuestra investigación. Existen también variantes que inciden con menor frecuencia que dichos patrones, estas comprenden el grupo II de la clasificación planteada en el presente trabajo.

SUMMARY: Testut & Latarjet (1980), Bouchet & Cuilleret (1986), Latarjet & Liard (2005) y Rouvière & Delmas (2005) describe the intrinsic relationships of the renal pedicle (PR) from two coronal planes, the renal pelvis (PER) being the element that limits between both. Trivedi et al. (2011) showed relationships between the elements of the RP that do not coincide with the descriptions provided by these authors. Knowing the possible variants in the intrinsic relationships of the RP is of the utmost importance in surgical practices such as renal transplantation (García de Jalón Martínez et al., 2003). Therefore, the objective of this study is to analyze the variable relationships between the elements that make up the RP in the juxtahilar region of the kidney. 23 RP were studied, formalized at 10 % and provided by the Dissection Team of the Second Chair of Anatomy of the University of Buenos Aires. PRs were classified into two groups. In Group I, the tributaries of origin of the renal vein (RVOA) were in the same coronal plane. In group II, the AOVRs were in different coronal planes. Each group was subdivided into different patterns. Patterns I and II, with the highest incidence, were associated with group I and patterns III, IV and V with group II. In pattern I, the VROA were anterior to the renal pelvis (PER) and posterior to the prepelvic artery (PPA). In pattern II, AOVRs were prior to PER and APP. Patterns I and II make up group I and presented a higher number of incidence in our investigation. There are also variants that occur less frequently than these patterns, these comprise group II of the classification proposed in this work.

Embolización de la arteria renal: serie de casos y revisión de la literatura / Renal artery embolization: case series and literature review

Resumen Introducción: La embolización de arteria renal (EAR) es un procedimiento percutáneo que ocluye la arteria renal, con la consecuente isquemia del territorio vascular. Sus indicaciones más comunes son la hematuria y el manejo paliativo en cáncer renal metastásico. A pesar del desarrollo técnico y de la experiencia progresiva, los estudios incluyen un número reducido de pacientes y en nuestro país se revisan casos aislados. Objetivo: Describir la experiencia en el Servicio de Salud Valparaíso San Antonio y revisar la literatura existente. Materiales y Método: Realizamos un estudio descriptivo de los pacientes sometidos a EAR por anemia severa secundaria a hematuria, durante los años 2012 a 2020. Posteriormente, realizamos una revisión de la literatura en PubMed, hasta abril de 2020. Resultados: Incluimos 9 pacientes, 6 (66,7%) hombres y 3 (33,3%) mujeres. La mediana de edad fue de 69 años (RIC = 18). La principal causa de la hematuria fue cáncer renal avanzado (7 pacientes). No hubo complicaciones, y se logró éxito clínico en todos los pacientes. Nuestra búsqueda de literatura arrojó 571 referencias y 24 cumplieron con nuestros criterios de elegibilidad. La edad de los pacientes y las causas subyacentes de hematuria fueron variadas. La menor tasa de éxito clínico fue de 65%, sin embargo, 15 estudios (62,5%) reportaron un éxito igual o mayor al 90%. Seis estudios reportaron más de un 10% de pacientes con alguna complicación. Conclusión: Nuestros resultados y la evidencia revisada muestran que la EAR parece ser segura y eficaz en el manejo de anemia severa secundaria a hematuria.

Introduction: Renal artery embolization (RAE) is a percutaneous procedure that occludes the renal artery, with consequent ischemia of the vascular territory. The most common indications include hematuria and palliation for metastatic renal cancer. Despite technical development and progressive experience, studies include a small number of patients and few cases have been published in our country. Aim: To share our experience at Valparaíso-San Antonio Health Service and to review the existing literature. Materials and Method: We performed a retrospective descriptive review of medical records of patients with severe anemia due to hematuria managed with RAE, between 2012 and 2020. Subsequently, we conducted a literature search in PubMed, from inception until April 2020. Results: We included 9 patients. There were 6 (66.7%) males and 3 (33.3%) females with a median age of 69 years (IQR = 18). Main cause of hematuria was advanced kidney cancer (7 patients). There were no complications and clinical success was achieved in all patients. Our literature search yielded 571 references, 24 met our eligibility criteria. The age of patients and the underlying causes of hematuria were varied. The lowest clinical success rate was 65%, however, 15 studies (62.5%) reported a success equal to or greater than 90%. Six studies reported more than 10% of patients with complications. Conclusión: Our results and the studies reviewed show that RAE appears to be safe and effective in the management of patients with severe anemia due to hematuria.

Denervação de artéria renal em paciente com hipertensão arterial refratária / Renal denervation in patient with refrataryarterial hypertension

Caso clínico de uma paciente com quadro de hipertensão arterial refratária, sendo inicialmente atribuída como etiologia a displasia de artéria renal. Os níveis pressóricos mantiveram elevados após a angioplastia de artéria renal, mantendo descontrole pressórico apesar do uso de 10 classes de anti-hipertensivos. Foi indicada a denervação de artéria renal e após tal, foi possível redução das medicações e êxito no controle de seus níveis tensionais. Destaca-se a importância do adequado diagnóstico de hipertensão arterial refratária, a exclusão de hipertensão secundária, somado à otimização terapêutica e indicação de procedimentos quando necessário, tendo como objetivo o melhor controle pressórico e consequente redução de lesões de órgãos-alvo e eventos cardiovasculares graves (AU).

It will be explained the patient clinical case of with refractory hypertension, which was initially attributed to renal artery dysplasia, but after the renal artery angioplasty, remained with high blood pressure levels despite adequate anti-hypertensive drugs administration. Renal denervation was indicated and after medications was reduced, with adequate blood pressure level control. It emphasizes the importance of secondary hypertension diagnosis, therapeutic optimization and specific therapies, if necessary, with the aim to take blood pressure control and the consequent reduction of target-organ damage and severe vascular events (AU).

Denervação simpática renal no tratamento da hipertensão arterial resistente: relato de caso / Renal sympathetic denervation in the treatment of resistant arterial hypertension: case report

Introdução: A hipertensão arterial sistêmica (HAS) pode levar a consequências cardiovasculares graves quando não tratadas adequadamente. No entanto, alguns indivíduos, mesmo realizando tratamento recomendado, a pressão arterial (PA) se mantém elevada, passando a ser chamada de hipertensão arterial refratária (HAR). A denervação simpática renal (DSR) é uma terapia amplamente estuda e com resultados promissores que surgiu como alternativa para controlar a PA em pacientes resistentes ao tratamento convencional. Relato de caso: Participante da pesquisa, sexo masculino, 67 anos, com queixa de cefaleia e elevação dos níveis pressóricos. Avaliação cardíaca com alteração apenas da PA (182x113 mmHg), demais sistemas sem variações. Diagnosticado com HAS estágio 3, realizou todas as etapas do tratamento medicamentoso, porém resistente as terapias propostas. Diante do caso, foi diagnosticado com HAR. Sendo realizado DSR que mostrou resultados satisfatórios de redução progressiva da pressão arterial central e periférica. Conclusão: A DSR mostrou-se eficaz no controle gradual e sustentado da PA do participante da pesquisa. Contudo, somente através de estudos clínicos mais amplos e rigorosos será capaz de comprovar a eficácia da DSR no tratamento da PA alta persistente (AU).

Introduction: Systemic arterial hypertension (SHT) can lead to severe cardiovascular outcomes when not properly treated. However, in some individuals, even with recommended treatment, blood pressure (BP) remains high, and is now referred to as Resistant hypertension (RHTN). Renal sympathetic denervation (RDn) is a widely studied and promising therapy that has emerged as an alternative to control BP in patients resistant to conventional treatment. Case report: Research participant, male, 67 years old, complaining of headache and elevated blood pressure. Cardiac assessment with only BP alteration (182x113 mmHg), other systems without variations. Diagnosed with stage 3 hypertension, performed all stages of drug treatment, but resistant to the proposed therapies. Given the case, was diagnosed with RHTN. Being performed RDn that showed satisfactory results of progressive reduction of central and peripheral blood pressure. Discussion: Sympathetic hyperactivity of the renal nervous system releases catecholamines that raise BP. Based on this, the RDn uses a catheter connected to the radiofrequency device that through the femoral artery goes to the two renal arteries and emits energy in the sympathetic fibers attached to the walls of these arteries, destroying them. RDn has been the target of several clinical studies, the best-known being Simplicity HTN-1, 2 and 3 which brought significant and questionable results regarding the efficacy of the procedure. Conclusion: RDn proved to be effective in gradually and sustained BP control of the research participant. However, only through broader and more rigorous clinical studies will it be able to prove the efficacy of RDn in combating persistent high BP (AU).

Misdiagnosis of Acute Renal Artery Thrombosis as Acute Abdominal Disease:Report of One Case / 中国医学科学院学报

Renal artery thrombosis can cause acute occlusion of unilateral or bilateral renal arteries,and kidney failure would be induced if it is not diagnosed and treated in time.Therefore,rapid and correct treatment is especially important for renal artery thrombosis.Due to the lack of specificity of clinical manifestations,this disease in commonly misdiagnosed or missed and thus has a low early diagnosis rate.Here we report a case of acute renal artery thrombosis to improve the diagnosis and treatment.

Coarctação de aorta abdominal justarrenal associada à hipertensão renovascular e claudicação incapacitante: tratamento utilizando ponte ilíaco-birrenal e técnica "paving and cracking" / Coarctation of the abdominal aorta associated with renovascular hypertension and incapacitating claudication: repair with iliac-birenal bypass and paving and cracking technique

Resumo Coarctação da aorta abdominal é uma causa rara de claudicação de membros inferiores e hipertensão refratária. O tratamento é complexo e exige conhecimento de diversas técnicas de reconstrução vascular. Apresentamos um caso de coarctação ao nível das artérias renais, seu tratamento e revisão da literatura. Paciente feminina, 65 anos, com hipertensão refratária desde os 35 anos, utilizando cinco medicações anti-hipertensivas em dose máxima. Pressão arterial média de 260/180mmHg e claudicação incapacitante (menos de 20 metros) bilateral. Angiotomografia computadorizada demonstrou coarctação de aorta justarrenal de 4 mm de maior diâmetro, calcificação circunferencial no local da estenose e tortuosidade da aorta infrarrenal. Foi submetida a tratamento híbrido, com ponte ilíaco-birrenal e implante de stent Advanta V12 no local da estenose. A paciente evoluiu satisfatoriamente e, 60 dias depois da cirurgia, apresentava-se com uma pressão arterial de 140/80mmHg, em uso de apenas duas medicações anti-hipertensivas e sem claudicação.

Abstract Coarctation of the abdominal aorta is a rare etiology of intermittent claudication and refractory hypertension. Treatment is complex and requires knowledge of several vascular reconstruction techniques. We report a case of aortic coarctation at the level of the renal arteries, describing its treatment and presenting a literature review. Female patient, 65 years old, with refractory hypertension since the age of 35, using five antihypertensive medications at maximum doses. Blood pressure was 260/180mmHg and she had disabling claudication (less than 20 meters). Computed tomography angiography showed a 4mm coarctation in the juxtarenal aorta, with circumferential calcification at the stenosis site, and tortuous infrarenal aorta. Hybrid repair was performed with an iliac-birenal bypass and implantation of an Advanta V12 stent at the stenosis site. The patient's postoperative course was satisfactory, she was free from claudication, and her blood pressure 60 days after surgery was 140/80mmHg, taking two antihypertensive medications.

Multilayer stents affect the final diameter of aortic aneurysms and maintain renal artery patency for a short time in a swine experimental model

OBJECTIVES: We sought to analyze the hemodynamic effects of the multilayer flow-modulated stent (MFMS) in Thoracoabdominal aortic aneurysms (TAAAs). METHODS: The hemodynamic effects of MFMS were analyzed in aortic thoracoabdominal aneurysms in experimental swine models. We randomly assigned 18 pigs to the stent or control groups and underwent the creation of an artificial bovine pericardium transrenal aneurysm. In the stent group, an MFMS (Cardiatis, Isnes, Belgium) was immediately implanted. After 4 weeks, we evaluated aneurysm sac thrombosis and renal branch patency by angiography, duplex scan, and morphological analysis. RESULTS: All the renal arteries remained patent after re-evaluation in both groups. Aneurysmal sac thrombosis was absent in the control group, whereas in the stent group it was present in 66.7% of aneurysmal sacs (p=0.061). The mean final aneurysm sac diameter was significantly lower in the stent group (mean estimated reduction, 6.90 mm; p=0.021). The proximal neck diameter decreased significantly in the stent group (mean difference, 2.51 mm; p=0.022) and grew significantly in the control group (mean difference, 3.02 mm; p=0.007). The distal neck diameter increased significantly in the control group (mean difference, 3.24 mm; p=0.017). There were no significant findings regarding distal neck measurements in the stent group. CONCLUSION: The MFMSs remained patent and did not obstruct the renal arteries within 4 weeks. In the stent group, the device was also associated with a significant decrease in aneurysmal sac diameter and a large proportion (albeit non-significant) of aneurysmal sac thrombosis.

Endovascular treatment of wide-neck saccular renal artery aneurysm with waffle-cone technique / Tratamento endovascular de aneurisma renal sacular com colo largo com técnica do waffle-cone

Abstract In the past, treatment of visceral artery aneurysms (VAAs) was exclusively surgical. These aneurysms were rarely diagnosed in elective or emergency cases. Development of imaging techniques and endovascular procedures has changed the history of the therapeutic options for this pathology. Endovascular management of VAAs has arisen to advances in endovascular techniques and has achieved high efficacy.

Resumo No passado, o tratamento de aneurismas da artéria visceral (VAAs) era exclusivamente cirúrgico e raramente diagnosticado em casos eletivos ou de emergência. O desenvolvimento de técnicas de imagem e procedimentos endovasculares mudou a história das opções terapêuticas dessa patologia. O manejo endovascular de VAAs surgiu devido ao avanço das técnicas endovasculares, o qual apresentou uma alta eficácia.

Resultado imediato do tratamento endovascular com stents paralelos do aneurisma roto justarrenal / Immediate outcome of endovascular treatment of ruptured juxtarenal aneurysm with parallel stents

Resumo A ruptura do aneurisma de aorta abdominal é um evento com alta mortalidade, e o seu tratamento nesses casos é uma emergência médica. O tratamento endovascular desses aneurismas tem se estabelecido como uma alternativa minimamente invasiva à cirurgia aberta clássica, tornando-se a opção de primeira escolha. Contudo, 20 a 50% dos pacientes portadores de aneurisma de aorta abdominal não apresentam anatomia favorável para o tratamento endovascular devido à presença de colo curto ou pelo acometimento de ramos viscerais pelo aneurisma. Relatamos um caso de uma paciente de 70 anos submetida à correção endovascular de aneurisma roto justarrenal com implante de stents paralelos para as renais (técnica de chaminé). São apresentados dados clínicos e detalhes do procedimento. O sucesso técnico foi obtido e não houve relato de complicações pós-operatórias.

Abstract Rupture of an abdominal aortic aneurysm is an event with a high mortality rate and treatment is a medical emergency. Endovascular treatment of these aneurysms has become established as a minimally invasive alternative to classical open surgery and is now the first-choice option. However, 20 to 50% of patients with abdominal aortic aneurysms do not have anatomy favorable for endovascular treatment because of a short aneurysm neck or because visceral branches are involved by the aneurysm. We report the case of a 70-year-old patient who underwent endovascular repair of a ruptured juxtarenal aneurysm with deployment of parallel stents in the renal arteries (in a chimney technique). Clinical data and details of the procedure are reported. Technical success was achieved and there were no postoperative complications.

Endovascular stenting with a drug-eluting stent of transplanted renal artery stenosis in a dual kidney transplanted patient / Tratamento endovascular com stent farmacológico em estenose de artéria renal transplantada de paciente com transplante renal duplo

Abstract Renal transplant remains the preferred therapy for end-stage renal disease (ESRD). Given the shortage of suitable donor kidneys, use of an expanded criteria donor (ECD) allows marginal kidneys to be transplanted; albeit at risk of increased graft failure due to lower nephron mass. To reduce the risk of graft failure, double kidney transplant (DKT) is advocated, with favorable outcomes. Transplant renal artery stenosis (TRAS) is one of the most common vascular complications following renal transplant. Unlike single kidney transplants, where TRAS usually presents with fluid overload, uncontrolled hypertension, and worsening kidney functions; it may be clinically silent in DKT patients since they have two functional transplanted kidneys. We hereby report a case of TRAS in a DKT patient who had 2 years of favorable clinical outcomes following successful endovascular stenting. He however recently died of COVID-19 associated pneumonitis.

Resumo O transplante renal continua sendo a terapia preferida para doenças renais em fase terminal. Dada a escassez de rins de doadores adequados, o doador com critérios expandidos permite que rins marginais sejam transplantados, embora haja um maior risco de falha do enxerto devido à diminuição da massa nefrótica. Para diminuir o risco de falha do enxerto, recomenda-se o transplante renal duplo (TRD), com resultados favoráveis. A estenose de artéria renal transplantada (EART) é uma das complicações vasculares mais comuns após o transplante renal. Ao contrário dos transplantes de rim simples, nos quais a EART geralmente se manifesta como sobrecarga de fluido, hipertensão descontrolada e piora das funções renais, ela pode ser clinicamente silenciosa em pacientes com TRD, pois eles têm dois rins funcionais transplantados. Relatamos aqui um caso de EART em um paciente com TRD que teve resultados clínicos favoráveis por dois anos após o sucesso do implante de stent endovascular. No entanto, ele morreu recentemente de pneumonite associada à covid-19.

Simultaneous endovascular revascularization of external iliac artery dissection and transplant renal artery stenosis in a recent renal allograft recipient / Revascularização endovascular simultânea de dissecção da artéria ilíaca externa e de estenose da artéria renal transplantada em receptor recente de aloenxerto renal

Abstract Various vascular complications following renal transplantation include renal artery and vein thrombosis, renal artery stenosis, pseudoaneurysm, and iliac artery dissection. Transplant renal artery stenosis (TRAS) is the most common, while iliac artery dissection is the rarest of these various vascular complications. We describe an elderly male, who had both external iliac artery dissection and TRAS at 2 months following renal transplantation. He underwent successful percutaneous endovascular intervention of both complications. The post-intervention course was uneventful, with improvement in graft renal functions and left lower limb perfusion.

Resumo As diversas complicações vasculares possíveis após um transplante renal incluem trombose da veia e artéria renais, estenose da artéria renal, pseudoaneurisma e dissecção da artéria ilíaca. Entre essas diversas complicações, a estenose da artéria renal transplantada é a mais comum, enquanto a dissecção da artéria ilíaca é a mais rara. Relatamos o caso de um homem idoso que desenvolveu tanto dissecção da artéria ilíaca quanto estenose da artéria renal transplantada 2 meses após transplante renal. As intervenções endovasculares percutâneas foram bem-sucedidas em ambas as complicações. O período pós-intervenção cursou sem complicações, com melhora na função renal do enxerto e na perfusão do membro inferior esquerdo.

Técnica de remodelamento com uso de stents em T e molas para tratamento de aneurisma renal complexo / Remodeling technique using T-stenting and coils to treat complex renal aneurysm

Resumo O aneurisma da artéria renal é uma condição rara, que vem sendo cada vez mais diagnosticada devido ao uso mais amplo da angiotomografia. Descrevemos um caso de aneurisma da artéria renal tipo II complexo em uma paciente com hipertensão arterial sistêmica e doença renal crônica não dialítica. O tratamento estabelecido foi o reparo endovascular através da combinação da técnica de remodelamento com stents em T e molas, para a preservação dos ramos arteriais renais. Foram obtidos resultados arteriográficos satisfatórios e boa evolução clínica.

Abstract Renal artery aneurysm is a rare condition that is being diagnosed with increasing frequency because of wider use of angiotomography. We describe a case of complex type II renal artery aneurysm in a patient with systemic arterial hypertension and non-dialysis chronic kidney disease. The treatment performed was endovascular repair using the remodeling technique with T-stenting and coils to preserve the renal arterial branches, obtaining satisfactory arteriographic results and good clinical outcomes.

Ex-vivo repair for multiple and intraparenchymal renal artery aneurysms / Reparo Ex Vivo de Aneurismas Intraparenquimatosos Múltiplos da Artéria Renal

Abstract A 45-year-old woman with known hypothyroidism and no other comorbidities was incidentally found to have multiple right renal artery aneurysms. The largest aneurysm measured 5 x 4.5 cm and arose from an inferior segmental branch while two smaller aneurysms arose from an upper segmental branch of the right renal artery. We performed an ex-vivo repair with reverse saphenous vein graft under cold preservation followed by orthotopic kidney auto-transplantation. Her postoperative course was unremarkable and at 1-year follow-up her right kidney is preserved. In this article, we report successful treatment of complex multiple right renal artery aneurysms and describe the surgical technique used for successful repair.

Resumo Uma mulher de 45 anos com hipotireoidismo conhecido e sem outras comorbidades teve achado incidental de múltiplos aneurismas da artéria renal direita. O maior aneurisma media 5 x 4,5 cm e tinha origem no ramo segmentar inferior, juntamente com dois pequenos aneurismas originários do ramo segmentar superior da artéria renal direita. Realizamos o reparo ex vivo com enxerto reverso de veia safena, sob preservação a frio, seguido de autotransplante renal ortotópico. O pós-operatório ocorreu sem intercorrências, e a paciente teve o rim direito preservado no seguimento de 1 ano. Neste artigo, relatamos o tratamento bem-sucedido de múltiplos aneurismas complexos da artéria renal direita e descrevemos a técnica cirúrgica utilizada para o reparo bem-sucedido.

Anatomical background of ovine kidney for use as animal model: analysis of arterial segmentation, proportional volume of each segment and arterial injury after cranial pole partial nephrectomy

ABSTRACT Objective To study the arterial segments of ovine kidney, present a proportional volume analysis of each kidney arterial segment, and analyze arterial injuries caused by simulated partial nephrectomy of cranial pole. Materials and Methods Forty-eight ovine kidneys injected with polyester resin into the renal arteries and collecting system were used in this study. Eighteen kidneys were used to study the arterial segments and the proportional volume of each renal segment. Other 30 kidneys were submitted to superior pole resection at a distance of 1.0cm, 0.5cm, or exactly at the cranial hilar edge, just before the resin hardening. These endocasts were used to evaluate the arterial injuries caused by these different resection planes. Results Ovine renal artery divided into two (ventral and dorsal) or three segmental arteries. Dorsal segment presented higher proportional volume than ventral segment. For kidneys with three segments, the third segment was on the caudal region (caudo-ventral or caudo-dorsal segment) and presented the lowest proportional volume. None of the resected kidneys (at 1.0, 0.5 or at the cranial hilar edge) presented injury of arterial branches that irrigate non-resected region. Conclusion The segmental distribution of renal artery, the proportional volume of each segment and arterial injuries after cranial pole resection in ovine kidneys are different from what is observed in human kidneys. Meanwhile, ovine kidneys show a primary segmental division on anterior and posterior, as in humans, but different from swine. These anatomical characteristics should be considered when using ovine as animal models for renal experimental and/or training procedures.

Cbfa1 expression in vascular smooth muscle cells may be elevated by increased nitric oxide/iNOS / A expressão de Cbfa1 nas células do músculo liso vascular pode ser elevada pelo aumento do óxido nítrico/iNOS

ABSTRACT Introduction: Vascular calcification is a common complication of chronic kidney disease. Osteoblast differentiation factor (Cbfa1) is present in histologic sections of arteries from patients with end-stage renal disease. Vascular smooth muscle cells (VSMC) can dedifferentiate to osteoblast-like cells, possibly by up-regulation of Cbfa1. There is evidence that the production of nitric oxide (NO) may have an important role in the regulation of osteoblast metabolism. The aim of this study is to evaluate whether increased NO/iNOS expression causes an increase in cbfa1 expression in VSMC. Methods: VSMC were obtained from renal artery of Wistar male rats, treated for 72 hours with lipopolysaccharide (LPS), ß-glycerophosphate (BGF), a donor of phosphate and aminoguanidine (AG), an inhibitor of iNOS, in the following groups: CTL (control), LPS, BGF, LPS + BGF, and LPS + AG. NO synthesis was determined by chemiluminescence. Cbfa1 and iNOS mRNA expressions were analyzed by RT-PCR, Cbfa1 protein expression by immunohistochemistry and cellular viability by acridine orange. Results: Cbfa1 and iNOS mRNA expressions were higher in LPS and LPS+ BGF vs CTL (p < 0.05), and they were lower in LPS+AG vs LPS (p < 0.05). The Cbfa1 in the groups LPS and LPS+BGF also resulted in a higher value compared to CTL (p < 0.05), and in LPS+AG it was lower compared to LPS (p < 0.05). NO was higher in LPS and LPS+BGF compared to CTL group (p < 0.05) and lower in LPS + AG compared to LPS group (p < 0.05). Cellular viability showed no statistical difference among groups. Conclusion: This study showed that increased NO/iNOS expression causes an increase in cbfa1 expression in VSMC.

RESUMO Introdução: A calcificação vascular é uma complicação comum da doença renal crônica. O fator de diferenciação osteoblástica (Cbfa1) está presente em cortes histológicos das artérias de pacientes com doença renal em estágio terminal. As células do músculo liso vascular (CMLV) podem desdiferenciar para células do tipo osteoblastos, possivelmente pela regulação positiva da Cbfa1. Há evidências de que a produção de óxido nítrico (NO) pode ter um papel importante na regulação do metabolismo dos osteoblastos. O objetivo deste estudo é avaliar se o aumento da expressão de NO/iNOS causa um aumento na expressão de cbfa1 nas CMLV. Métodos: As CMLV foram obtidas da artéria renal de ratos machos Wistar, tratados por 72 horas com lipopolissacarídeo (LPS), ß-glicerofosfato (BGF), um doador de fosfato e aminoguanidina (AG), um inibidor da iNOS, nos seguintes grupos: CTL (controle), LPS, BGF, LPS + BGF e LPS + AG. A síntese de NO foi determinada por quimioluminescência. As expressões de mRNA de Cbfa1 e iNOS foram analisadas por RT-PCR, a expressão da proteína Cbfa1 por imunohistoquímica e viabilidade celular por laranja de acridina. Resultados: As expressões de mRNA de Cbfa1 e iNOS foram maiores em LPS e LPS + BGF v.s. CTL (p < 0,05) e menores em LPS + AG v.s. LPS (p <0,05). O Cbfa1 nos grupos LPS e LPS + BGF também resultou em um valor maior em comparação ao CTL (p < 0,05), e no LPS + AG foi menor em comparação ao LPS (p < 0,05). NO foi maior no LPS e LPS + BGF em comparação ao grupo CTL (p < 0,05) e menor no LPS + AG em comparação ao grupo LPS (p < 0,05). A viabilidade celular não mostrou diferença estatística entre os grupos. Conclusão: Este estudo mostrou que o aumento da expressão de NO/iNOS causa um aumento na expressão de cbfa1 nas CMLV.

Descripción anatómica de la arteria polar renal accesoria y su relación con la hipertensión arterial / Anatomical description of accessory renal polar artery and its relationship with arterial hypertension

La irrigación renal incluye la arteria renal y las arterias renales accesorias. Uno de estos vasos accesorios es la arteria polar renal superior o inferior. Estos vasos tienen un desarrollo embrionario y un origen anatómico similar a la arteria renal, tanto en la aorta abdominal como en sus ramas. Irrigan los segmentos renales correspondientes y se ha observado que su obliteración puede ser causa de aumento de la presión arterial, al estimular un aumento de renina circulante. El objetivo de este trabajo, es presentar un reporte de caso clínico de paciente masculino de 24 años, sin antecedentes mórbidos. Consulta por un cuadro de cefalea y mareos de 2 semanas de evolución. Clínicamente se pesquisó aumento de presión arterial y obesidad, sin fiebre ni otros hallazgos significativos. Los exámenes complementarios arrojan las siguientes alteraciones: triglicéridos (aumentados), presión arterial (aumentada), renina (aumentada) y AngioTac de abdomen evidenció una arteria renal polar accesoria superior izquierda, con estenosis vascular. La literatura indica que la hipertensión arterial esta correlacionada con la obstrucción parcial o total de una arteria renal o de una rama accesoria. Esta alteración en la disminución del flujo sanguíneo podría estimular la liberación de renina al torrente sanguíneo, afectando la presión arterial. Nuestros hallazgos concuerdan con lo descrito en la literatura y requieren ser considerados en el diagnóstico de hipertensión arterial. Este caso evidencia la necesidad de realizar una revisión exhaustiva de la base anatómica de la medicina con un enfoque integrativo, lo que permitirá mejorar el diagnóstico, el tratamiento y el pronóstico de patologías donde esta información es poco clara o inexistente.

The kidney irrigation includes the renal artery and the accessory renal arteries. One of these accessory vessels is the superior or inferior renal polar artery. These vessels have an embryonic development and an anatomical origin similar to the renal artery, both in the abdominal aorta but also of its branches. Irrigate the corresponding renal segments and it has been observed that their obliteration may cause increased blood pressure, by stimulating an increase in circulating renin. The objective of this work is to present a clinical case report of a 24year-old male patient, with no morbid history. Consultation due to headache and dizziness symptoms with 2 weeks of evolution. Clinically increased blood pressure and obesity, without fever or other significant findings. Corresponding exams showed the following changes: triglycerides (increased), blood pressure (increased), renin (increased) and abdominal AngioTac showed a left upper accessory polar renal artery with vascular stenosis. The literature indicates that arterial hypertension is correlated with partial or total obstruction of a renal artery or an accessory branch. This alteration in the decrease in blood flow could stimulate the release of renin into the bloodstream, affecting blood pressure. Our findings agree with what is described in the literature and need to be considered in the diagnosis of arterial hypertension. This case demonstrates the need for an exhaustive review of the anatomical basis of medicine with an integrative approach. This would improve diagnosis, treatment and prognosis of pathologies where this information is unclear or non-existent.

Arteria renal doble en Cerdocyon thous / Double Renal Artery in Cerdocyon thous

RESUMEN Objetivo. El propósito de este estudio fue explorar la duplicidad de la arteria renal en un espécimen de Cerdocyon thous, centrándose en las posibilidades de la implicación clínico-quirúrgica de esta variación anatómica. Materiales y Métodos. Fueron disecados 32 especímenes de Cerdocyon thous, obtenidos de las colecciones del Laboratorio de Enseñanza e Investigación en Morfología de los Animales Domésticos y Salvajes del Departamento de Anatomía Animal y Humana, de la Universidad Federal Rural del Rio de Janeiro y del Laboratorio de Anatomía Animal de la Universidad Federal del Pampa. Resultados. Fue observada una variación numérica en la arteria renal izquierda en un cadáver hembra adulto. El riñón izquierdo tenía dos arterias renales, una craneal y otra caudal. La primera arteria renal del riñón izquierdo, midiendo 2,25 cm de longitud, se ha originado lateralmente desde la aorta abdominal a nivel de la tercera vértebra lumbar. Además, emanaba dos ramas prehiliares, una dorsal y otra ventral, con la rama ventral suministrando también a la glándula suprarrenal. La segunda arteria renal también se ha originado lateralmente desde la aorta abdominal a nivel de la tercera vértebra lumbar, midiendo 2,36 cm de longitud. También ha emitido dos ramas prehiliares, una craneal y otra caudal, las cuales emitieron la rama uretral. Conclusiones. Las variaciones numéricas de las arterias renales deben ser consideradas en la ejecución de procedimientos quirúrgicos, radiológicos y experimentales, con los fines de evitar errores ocasionados por la falta de conocimiento de la posibilidad de estas variaciones tanto en animales domésticos como salvajes.

ABSTRACT Objective. The aim of this study was explored the duplicity of renal artery in a specimen of Cerdocyon thous, focusing on the possibilities of clinical-surgical implication of this anatomical variation. Materials and methods. Were dissected 32 specimens of Cerdocyon thous, obtained from the collections of the Laboratório de Ensino e Pesquisa em Morfologia dos Animais Domésticos e Selvagens do Departamento de Anatomia Animal e Humana, da Universidade Federal Rural do Rio de Janeiro e Laboratório de Anatomia Animal da Universidade Federal do Pampa. Results. Were observed a numerical variation in the left renal artery in an adult female cadaver. The left kidney had two renal arteries, one cranial and another caudal. The first renal artery of the left kidney, measuring 2.25 cm in length, originated laterally from the abdominal aorta at the level of the third lumbar vertebra. Moreover, it emanated two pre-hilar branches, one dorsal and one ventral, with the ventral branch supplying also to the adrenal gland. The second renal artery also originated laterally from the abdominal aorta at the level of the third lumbar vertebra and measured 2.36 cm in length. It also emitted two pre-hilar branches, one cranial and another caudal, which emitted the ureteral branch. Conclusions. Numerical variations of the renal arteries should be considered in the execution of surgical, radiological and experimental procedures in order to avoid mistakes made due to lack of knowledge of the possibility these variations both in domestic and wild animals.