• Archives of Plastic Surgery
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• v.44 no.3
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• pp.238-242
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• 2017

The most common anatomic variant seen in donor kidneys for renal transplantation is the presence of multiple renal arteries, which can cause an increased risk of complications. Accessory renal arteries should be anastomosed to the proper source arteries to improve renal perfusion via the appropriate vascular reconstruction techniques. In microsurgery, 2 kinds of vascular augmentation methods, known as 'supercharging' and 'turbocharging,' have been introduced to ensure vascular perfusion in the transferred flap. Supercharging uses a distant source of the vessels, while turbocharging uses vascular sources within the same flap territory. These technical concepts can also be applied in renal transplantation, and in this report, we describe 2 patients who underwent procedures using supercharging and turbocharging. In one case, the ipsilateral deep inferior epigastric artery was transposed to the accessory renal artery (supercharging), and in the other case, the accessory renal artery was anastomosed to the corresponding main renal artery with a vascular graft (turbocharging). The transplanted kidneys showed good perfusion and proper function. No cases of renal failure, hypertension, rejection, or urologic complications were observed. These microsurgical techniques can be safely utilized for renal transplantation with donor kidneys that have multiple arteries with a lower complication rate and better outcome.

• The Korean Journal of Nuclear Medicine
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• v.37 no.3
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• pp.199-201
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• 2003

A 38-year-old woman with end stage renal disease received a living related donor-renal transplant to the right iliac fossa. She developed anuria a week later Tc-99m $MAG_3$ renal scintigraphy demonstrated no perfusion, uptake, or excretion of the radioactive tracer from the renal transplant. The expected area of the renal allograft appeared as a photopenic area with increased rim activity. The gallbladder and bowel activities were observed on delayed images at 24 hours. There was no blood flow within the renal artery on renal doppler examination. This case shows total absence of perfusion and function in the infarcted renal transplant with extrarenal excretion of Tc-99m $MAG_3$ caused by acute renal artery thrombosis.

• The Korean Journal of Physiology and Pharmacology
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• v.10 no.6
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• pp.337-341
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• 2006

The present study was designed to investigate the protein expression of nitric oxide synthase (NOS) and guanylyl cyclase (GC) activity in ischemia/perfusion (I/R) renal injury in rats. Renal I/R injury was experimentally induced by clamping the both renal pedicle for 40 min in Sprague-Dawley male rats. The renal expression of NOS isoforms was determined by Western blot analysis, and the activity of guanylyl cyclase was determined by the amount of guanosine 3', 5'-cyclic monophosphate (cGMP) formed in response to sodium nitroprusside (SNP), NO donor. I/R injury resulted in renal failure associated with decreased urine osmolality. The expression of inducible NOS (iNOS) was increased in I/R injury rats compared with controls, while endothelial NOS (eNOS) and neuronal NOS (nNOS) expression was decreased. The urinary excretion of NO metabolites was decreased in I/R injury rats. The cGMP production provoked by SNP was decreased in the papilla, but not in glomerulus. These results indicate an altered regulation of NOS expression and guanylyl cyclase activity in I/R-induced nephropathy.

• Journal of Trauma and Injury
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• v.34 no.3
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• pp.198-202
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• 2021

Super-selective renal artery embolization is an increasingly popular technique for the management of traumatic, low-grade renal trauma. When performed in distal arterial branches, this intervention enables tissue preservation and arrest of hemorrhage, but it may not be practical in cases of multifocal, high-grade renal injuries. In such cases, surgical nephrectomy remains the more common treatment modality to ensure hemodynamic control. We present the unique case of a patient who presented in hemorrhagic shock following a major trauma that resulted in a grade 5 renal injury treated with complete renal artery embolization using Gelfoam, resulting in hemodynamic stabilization. Interestingly, imaging 1 month after embolization revealed residual enhancement of the inferior pole of the kidney, suggesting reconstitution of flow and partial renal salvage. Ultimately, transcatheter "nephrectomy" with careful selection of a temporary embolic agent may serve as a safe and efficient alternative to surgical nephrectomy with the added possibility of preserving partial renal perfusion and function in the emergent setting.

• Journal of Biomedical Engineering Research
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• v.28 no.4
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• pp.449-454
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• 2007

An electrohydraulic (EH) pump-driven closed-loop blood pressure regulatory system was developed based on flow-mediated vascular occlusion using the vascular occlusive cuff technique. It is very useful for investigating blood pressure-dependant physiological variability, in particular, that could identify the principal mediators of renal autoregulation, such as tubuloglomerular feedback (TGF) and myogenic (MYO), during blood pressure regulation. To address this issue, renal perfusion pressure (RPP) should be well regulated under various experimental conditions. In this paper, we designed a new EH pump-driven RPP regulatory system capable of implementing precise and rapid RPP regulation. A closed-loop servo-controlwas developed with an optimal proportional plus integral (PI) compensation using the dynamic feedback RPP signal from animals. An in vivo performance was evaluated in terms of flow-mediated RPP occlusion, maintenance, and release responses. Step change to 80 mmHg reference from normal RPP revealed steady state error of ${\pm}3%$ during the RPP regulatory period after PI action. We obtained rapid RPP release time of approximately 300 ms. It is concluded that the proposed EH RPP regulatory system could be utilized in in vivo performance to study various pressure-flow relationships in diverse fields of physiology, and in particular, in renal autoregulation mechanisms.

• The Korean Journal of Nuclear Medicine
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• v.34 no.6
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• pp.497-507
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• 2000

Purpose: We have examined the utility of $^{99m}Tc$-MAG3 perfusion indices for assessing renal graft function in early post-transplantation period. Materials and Methods: Our study included 80 renal transplant recipients (48 men and 32 women, mean age: 40.3 years). Diagnosis was based on biopsy, laboratory data and clinical course. Renal scintigraphy (RS) was obtained using 100 MBq of $^{99m}Tc$-MAG3 from 11 days to 23 days of kidney transplantation. We measured 5 indices in whole-kidney (WK) and cortical (C) renograms; Hilson's perfusion index (PI), transplant perfusion index (TP) and transplant function index (TF) as perfusion parameter, and the time to peak activity (Tmax) and the ratio of renal counts at 20 min to that at 3 min (K20/3) as functional parameter. Results: The diagnoses at the day of RS were normal graft (NG) in 44, acute rejection (AR) in 14, acute tubular necrosis (ATN) in 10, and Cyclosporine A nephrotoxicity (CsA) in 12. TP and TF were significantly decreased in AR, ATN and CsA, compared to those in NG. K20/3 of AR and ATN wore significantly greater than that of NG. WK-Tmax of AR was significantly longer than that of NG. K20/3 of AR and C-K20/3 of ATN were significantly prolonged relative to those of CsA. There were no statistically significant perfusion indices among complication groups. Conclusion: TP and TF reflecting microperfusion and initial tubular extraction are reliable in assessing graft function. However, it is required to correlate perfusion indices with functional indices and clinical course in differentiating from one another among complication groups.

• Journal of Chest Surgery
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• v.38 no.1 s.246
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• pp.13-22
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• 2005

It has been known that pulsatile flow is physiologic and more favorable to tissue perfusion than nonpulsatile flow. The purpose of this study is to directly compare the effect of pulsatile versus nonpulsatile blood flow to renal tissue perfusion in extracorporeal circulation by using a tissue perfusion measurement system. Material and Method: Total cardiopulmonary bypass circuit was constructed to twelve Yorkshire swines, weighing 20$\~ $30 kg. Animals were randomly assigned to group 1 (n=6, non pulsatile centrifugal pump) or group 2 (n=6, pulsatile T-PLS pump). A probe of the tissue perfusion measurement system $(QFlow^{TM}-500)$ was inserted into the renal pa­renchymal tissue. Extracorporeal circulation was maintained for an hour at a pump flow of 2 L/min after aortic cross-clamping. Tissue perfusion flow of the kidney was measured at baseline (before bypass) and every 10 minutes after bypass. Serologic parameters were collected at baseline and 60 minutes after bypass. Result: Baseline parameters were not different between the groups. Renal tissue perfusion flow was substantially higher in the pulsatile group throughout the bypass (ranged 48.5$\~$ 64 in group 1 vs. 65.8$\~$88.3 mL/min/100 g in group 2, p=0.026$\~$ 0.45) The difference was significant at 30 minutes bypass $(47.5{\pm}18.3\;in\;group\;1\;vs.\;83.4{\pm}28.5$ mL/min/100 g in group 2, p=0.026). Serologic parameters including plasma free hemoglobin, blood urea nitrogen, and creatinine showed no differences between the groups at 60 minutes after bypass (p=NS). Conclusion: Pulsatile flow is more beneficial to tissue perfusion of the kidney in short-term extracorporeal circulation. Further study is suggested to observe the effects to other vital organs or long-term significance.

• Clinical and Experimental Pediatrics
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• v.61 no.11
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• pp.339-347
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• 2018

Acute kidney injury (AKI) is characterized by abrupt deterioration of renal function, and its diagnosis relies on creatinine measurements and urine output. AKI is associated with higher morbidity and mortality, and is a risk factor for development of chronic kidney disease. There is no proven medication for AKI. Therefore, prevention and early detection are important. Physicians should be aware of the risk factors for AKI and should monitor renal function in high-risk patients. Management of AKI includes optimization of volume status and renal perfusion, avoidance of nephrotoxic agents, and sufficient nutritional support. Continuous renal replacement therapy is widely available for critically ill children, and this review provides basic information regarding this therapy. Long-term follow-up of patients with AKI for renal function, blood pressure, and proteinuria is recommended.

• YAKHAK HOEJI
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• v.17 no.1
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• pp.31-39
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• 1973

The influence of guanethidine on the renal function was investigated in the rabbit. Guanethidine, 1-10mg/kg, i.v., produced no marked change in the renal function, while second and successive doses of guanethidine elicited a significant increase in urine flow and electrolyte excretion as well as renal plasma flow and glomerular filtration rate. It was suggested that the diuretic action was brought about by improvement of hemodynamic state in the kidney ; increased filtration as a result of increased renal perfusion. Atropine alone did not significantly influence the renal function but pretreatment of animals with atropine, 4 mg/kg i.v., completely abolished the diuretic action of guanethidine. It is suggested that guanethidine influences the renal function by activating parasympathetic nervous system or some cholinergic mechanism in the kidney.

• Journal of Chest Surgery
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• v.29 no.4
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• pp.449-453
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• 1996

A successful resection of dissecting thoracoabdominal aortic aneurysm is presented in a patient who had undergone kidney transplantation 20 months previously. Because the transplanted kidney is more sensitive to ischemia than the normal kidney, a femoro-femoral bypass with a pump oxygenator was used for perfusion of the transplanted kidney during crossclamping. During the clamping time of 1)8 minutes, kidney perfusion was maintai ed with a perfusion pressure of (19 to 31) 27mmHg and the flow was 0.53 to 0.81 L/min. 32mm sized Hemashield (22 Cm in length) was interposed. The postoperative course was uncomplicated. We believe that performing the femoro- femoral bypass with a pump oxygenator is an effective and simple method for renal and spinal protection in such operations.