Hypoxic renal injury in newborns with abdominal compartment syndrome (clinical and experimental study)

Pediatr Res. 2018 Feb;83(2):520-526. doi: 10.1038/pr.2017.263. Epub 2017 Nov 15.

Abstract

BackgroundSurgical treatment for gastroschisis and congenital diaphragmatic hernia (CDH) commonly leads to abdominal compartment syndrome (ACS) associated with hypoxic renal injury. We hypothesized that measurement of urinary and serum concentrations of vascular endothelial growth factor (VEGF), π-glutathione S-transferase (π-GST), and monocyte chemoattractant protein-1 (MCP-1) may serve for noninvasive detection of hypoxic renal injury in such patients.MethodsIntra-abdominal pressure (IAP), renal excretory function, and the biomarker levels were analyzed before, 4, and 10 days after surgery. Association between the biomarker levels and renal histology was investigated using an original model of ACS in newborn rats.ResultsFour days after surgery, IAP increased, renal excretory function decreased, and the levels of VEGF, π-GST, and MCP-1 increased, indicating renal injury. Ten days after surgery, IAP partially decreased, renal excretory function completely restored, but the biomarker levels remained elevated, suggesting the ongoing kidney injury. In the model of ACS, increase in the biomarker levels was associated with progressing kidney morphological alteration.ConclusionSurgical treatment for gastroschisis and CDH is associated with prolonged hypoxic kidney injury despite complete restoration of renal excretory function. Follow-up measurement of VEGF, π-GST, and MCP-1 levels may provide a better tool for noninvasive assessment of renal parenchyma in newborns with ACS.

MeSH terms

  • Animals
  • Animals, Newborn
  • Biomarkers / metabolism
  • Chemokine CCL2 / metabolism
  • Compartment Syndromes / complications
  • Compartment Syndromes / pathology*
  • Congenital Abnormalities / surgery*
  • Disease Models, Animal
  • Female
  • Gastroschisis / metabolism
  • Gastroschisis / surgery*
  • Glutathione Transferase / metabolism
  • Hernia, Diaphragmatic / surgery
  • Hernias, Diaphragmatic, Congenital / surgery*
  • Humans
  • Hypoxia / physiopathology
  • Infant, Newborn
  • Intra-Abdominal Hypertension
  • Kidney / pathology
  • Male
  • Pressure
  • Prospective Studies
  • Rats
  • Rats, Wistar
  • Vascular Endothelial Growth Factor A / metabolism

Substances

  • Biomarkers
  • Chemokine CCL2
  • Vascular Endothelial Growth Factor A
  • Glutathione Transferase