The intrinsic renal compartment syndrome: new perspectives in kidney transplantation.
OBJECTIVE
Inflammatory edema after ischemia-reperfusion may impair renal allograft function after kidney transplantation. This study examines the effect of edema-related pressure elevation on renal function and describes a simple method to relieve pressure within the renal compartment.


METHODS
Subcapsular pressure at 6, 12, 24, 48 hr, and 18 days after a 45 min warm ischemia was determined in a murine model of renal ischemia-reperfusion injury. Renal function was measured by Tc-MAG3 scintigraphy and laser Doppler perfusion. Structural damage was assessed by histologic analysis. As a therapeutic approach, parenchymal pressure was relieved by a standardized circular 0.3 mm incision at the lower pole of the kidney capsule.


RESULTS
Compared with baseline (0.9+/-0.3 mm Hg), prolonged ischemia was associated with a sevenfold increase in subcapsular pressure 6 hr after ischemia (7.0+/-1.0 mm Hg; P<0.001). Pressure levels remained significantly elevated for 24 hr. Without therapy, a significant decrease in functional parameters was found with considerably reduced tubular excretion rate (33+/-3.5%, P<0.001) and renal perfusion (64.5+/-6.8%, P<0.005). Histologically, severe tissue damage was found. Surgical pressure relief was able to significantly prevent loss of tubular excretion rate (62.5+/-6.8%, P<0.05) and renal blood flow (96.2+/-4.8%; P<0.05) and preserved the integrity of renal structures.


CONCLUSIONS
Our data support the hypothesis of the existence of a renal compartment syndrome as a consequence of ischemia-reperfusion injury. Surgical pressure relief effectively prevented functional and structural renal impairment, and we speculate that this approach might be of value for improving graft function after renal transplantation.
Herrler
Tanja
T
Department of Surgery, Experimental Medicine, University of Munich, Munich, Germany. tanja.herrler@med.uni-muenchen.de
Tischer
Anne
A
Meyer
Andreas
A
Feiler
Sergej
S
Guba
Markus
M
Nowak
Sebastian
S
Rentsch
Markus
M
Bartenstein
Peter
P
Hacker
Marcus
M
Jauch
Karl-Walter
KW
D000818:Animals; D003161:Compartment Syndromes / Q000453:epidemiology* / Q000209:etiology; D007668:Kidney / Q000000981:diagnostic imaging; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000502:physiology*; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D011877:Radionuclide Imaging; D015427:Reperfusion Injury / Q000000981:diagnostic imaging / Q000473:pathology; D017263:Technetium Tc 99m Mertiatide
D017263:Technetium Tc 99m Mertiatide