Original communication| Volume 143, ISSUE 2, P243-251, February 2008

Increased severity of renal ischemia-reperfusion injury with venous clamping compared to arterial clamping in a rat model

Published:January 03, 2008DOI:


      Arterial inflow occlusion is a well-known mechanism of renal injury during major vascular surgery. In contrast, renal injury from venous outflow obstruction is poorly understood. The goal of this study was to examine the injury pattern of renal venous outflow obstruction, compare this with the traditional model of arterial occlusion, and examine possible mechanisms.


      Male Fisher rats were used for the renal warm ischemia model. Twenty-five minutes of renal ischemia was induced by selectively occluding either the renal artery or vein. After 24 h of reperfusion, whole blood and kidney tissue were collected for further analysis.


      Serum creatinine (SCr) concentrations taken 24 h after reperfusion were significantly greater in the venous occlusion group (V) when compared to the arterial group (A). While histology did not demonstrate significant differences in extent of necrosis between both groups, a stronger inflammatory response resulted from venous occlusion. Specifically, significantly greater MCP-1 mRNA and significantly greater MCP-1, TNF-α, and HO-1 protein levels were found in the venous group, while no differences in MIP-2, ICAM-1, and VCAM-1 mRNA expression existed between A and V. Further analysis demonstrated presence of increased cleaved caspase-3 protein in the artery group than in the venous group.


      Venous renal outflow obstruction results in more severe functional renal injury when compared to arterial inflow occlusion. Macrophage activation and neutrophilic infiltration appear to be exaggerated during venous occlusion.
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        • Myers S.I.
        • Wang L.
        • Liu F.
        • Bartula L.L.
        Oxygen-radical regulation of renal blood flow following suprarenal aortic clamping.
        J Vasc Surg. 2006; 43: 577-586
        • Myers S.I.
        • Wang L.
        • Liu F.
        • Bartula L.L.
        Suprarenal aortic clamping and reperfusion decreases medullary and cortical blood flow by decreased endogenous renal nitric oxide and PGE2 synthesis.
        J Vasc Surg. 2005; 42: 524-531
        • Niemann C.U.
        • Hirose R.
        • Stock P.
        • et al.
        Intraoperative fluid management of living donor versus cadaveric liver transplant recipients.
        Transplant Proc. 2004; 36: 1466-1468
        • Chertow G.M.
        • Soroko S.H.
        • Paganini E.P.
        • et al.
        Mortality after acute renal failure: models for prognostic stratification and risk adjustment.
        Kidney Int. 2006; 70: 1120-1126
        • Chiang W.C.
        • Chien C.T.
        • Lin W.W.
        • et al.
        Early activation of bradykinin B2 receptor aggravates reactive oxygen species generation and renal damage in ischemia/reperfusion injury.
        Free Radic Biol Med. 2006; 41: 1304-1314
        • Serkova N.
        • Fuller T.F.
        • Klawitter J.
        • et al.
        H-NMR-based metabolic signatures of mild and severe ischemia/reperfusion injury in rat kidney transplants.
        Kidney Int. 2005; 67: 1142-1151
        • De Greef K.E.
        • Ysebaert D.K.
        • Persy V.
        • et al.
        ICAM-1 expression and leukocyte accumulation in inner stripe of outer medulla in early phase of ischemic compared to HgCl2-induced ARF.
        Kidney Int. 2003; 63: 1697-1707
        • Furuichi K.
        • Wada T.
        • Iwata Y.
        • et al.
        Interleukin-1-dependent sequential chemokine expression and inflammatory cell infiltration in ischemia-reperfusion injury.
        Crit Care Med. 2006; 34: 2447-2455
        • Lee H.T.
        • Ota-Setlik A.
        • Fu Y.
        • et al.
        Differential protective effects of volatile anesthetics against renal ischemia-reperfusion injury in vivo.
        Anesthesiology. 2004; 101: 1313-1324
        • Jo S.K.
        • Sung S.A.
        • Cho W.Y.
        • et al.
        Macrophages contribute to the initiation of ischaemic acute renal failure in rats.
        Nephrol Dial Transplant. 2006; 21: 1231-1239
        • Hauge E.M.
        • Balling E.
        • Hartmund T.
        • Hjortdal V.E.
        Secondary ischemia caused by venous or arterial occlusion shows differential effects on myocutaneous island flap survival and muscle ATP levels.
        Plast Reconstr Surg. 1997; 99: 825-833
        • Kimura M.
        • Kataoka M.
        • Kuwabara Y.
        • et al.
        Real-time energy metabolism of intestine during arterial versus venous occlusion in the rat.
        J Gastroenterol. 2003; 38: 849-853
        • Guan Z.
        • Gobe G.
        • Willgoss D.
        • Endre Z.H.
        Renal endothelial dysfunction and impaired autoregulation after ischemia-reperfusion injury result from excess nitric oxide.
        Am J Physiol Renal Physiol. 2006; 291: F619-F628
        • Hetz H.
        • Bauer M.
        • Lahner D.
        • et al.
        Endothelin activation and postoperative renal failure after human liver transplantation.
        Liver Transpl. 2005; 11: 1201-1206
        • Furuichi K.
        • Wada T.
        • Iwata Y.
        • et al.
        CCR2 signaling contributes to ischemia-reperfusion injury in kidney.
        J Am Soc Nephrol. 2003; 14: 2503-2515
        • Kitagawa K.
        • Wada T.
        • Furuichi K.
        • et al.
        Blockade of CCR2 ameliorates progressive fibrosis in kidney.
        Am J Pathol. 2004; 165: 237-246
        • Sung F.L.
        • Zhu T.Y.
        • Au-Yeung K.K.
        • et al.
        Enhanced MCP-1 expression during ischemia/reperfusion injury is mediated by oxidative stress and NF-kappaB.
        Kidney Int. 2002; 62: 1160-1170
        • Kanwar Y.S.
        A dynamic interplay between monocyte chemoattractant protein-1 and heme oxygenase-1: implications in renal injury.
        Kidney Int. 2005; 68: 896-897
        • Shokawa T.
        • Yoshizumi M.
        • Yamamoto H.
        • et al.
        Induction of heme oxygenase-1 inhibits monocyte chemoattractant protein-1 mRNA expression in U937 cells.
        J Pharmacol Sci. 2006; 100: 162-166
        • Pittock S.T.
        • Norby S.M.
        • Grande J.P.
        • et al.
        MCP-1 is up-regulated in unstressed and stressed HO-1 knockout mice: Pathophysiologic correlates.
        Kidney Int. 2005; 68: 611-622