Renal Decapsulation Prevents Intrinsic Renal Compartment Syndrome in Ischemia-Reperfusion–Induced Acute Kidney Injury: A Physiologic Approach

Abstract

Objectives: Acute kidney injury is a serious complication with
unacceptably high mortality that lacks of specific curative treatment.
Therapies focusing on the hydraulic behavior have shown
promising results in preventing structural and functional renal
impairment, but the underlying mechanisms remain understudied.
Our goal is to assess the effects of renal decapsulation on
regional hemodynamics, oxygenation, and perfusion in an ischemic
acute kidney injury experimental model.
Methods: In piglets, intra renal pressure, renal tissue oxygen pressure,
and dysoxia markers were measured in an ischemia-reperfusion
group with intact kidney, an ischemia-reperfusion group
where the kidney capsule was removed, and in a sham group.
Results: Decapsulated kidneys displayed an effective reduction of
intra renal pressure, an increment of renal tissue oxygen pressure,
and a better performance in the regional delivery, consumption,
and extraction of oxygen after reperfusion, resulting in a marked
attenuation of acute kidney injury progression due to reduced
structural damage and improved renal function.
Conclusions: Our results strongly suggest that renal decapsulation
prevents the onset of an intrinsic renal compartment syndrome
after ischemic acute kidney injury