A hibernating kidney - ischemic preconditioning in a renal transplant recipient with a proximal stenosis of the iliac artery.
Ischemic preconditioning has been first described by Murry and coworkers as the protection conferred to ischemic myocardium by preceding brief periods of sublethal ischemia separated by periods of reperfusion. Another phenomenon closely associated to IPC is hibernation and stunning. The hibernating myocardium refers to resting left ventricular dysfunction due to reduced coronary blood flow that can be partially or completely reversed by myocardial revascularization and/or by reducing myocardial oxygen demand. Similarly as for the myocardium, these effects are reproducible for other solid organs. Here we report a case of a renal transplant recipient with decompensated proximal transplant artery stenosis due to ACE inhibition resulting in acute renal failure. The transplant perfusion was strictly dependent on systemic arterial blood pressure leading to intermittent episodes of renal ischemia and reperfusion. Renal function was severely decreased (glomerular filtration rate approximately 8 ml/min) with the need of hemodialysis treatment over a period of 4 weeks after transplantation. After dilatation of the stenosis, the patient's renal function improved rapidly and achieved values better than ever before. Referring to the definition of hibernating myocardium, here we postulate a case of a hibernating kidney in context of ischemic preconditioning.
Warncke
J
J
Department of Internal Medicine/Nephrology, Medical School Hannover, Germany.
David
S
S
Kümpers
P
P
Opherk
J P
JP
Haller
H
H
Fliser
D
D
D058186:Acute Kidney Injury / Q000209:etiology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000628:therapy; D006801:Humans; D007083:Iliac Artery; D019194:Ischemic Preconditioning; D007668:Kidney / Q000098:blood supply*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
D000806:Angiotensin-Converting Enzyme Inhibitors