Avaliação morfológica de rins de suínos submetidos à ablação renal por radiofrequência e comparação da densidade glomerular com rins submetidos à isquemia quente

• Autor(a) principal: Abreu, Leonardo de Albuquerque dos Santos
• Data de Publicação: 2017
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/12326
• topic: Kidney Neoplasms; Radiofrequency ablation; Renal function; Kidney glomerulus Density; Swine; Câncer renal; Ablação com radiofrequência; Função renal; Densidade de glomérulos; Suínos; Rins Câncer; Testes de função renal; Glomérulos renais; Técnicas de ablação; CNPQ::CIENCIAS DA SAUDE

Radiofrequency ablation (RF) is an option for treating small renal masses. Similarly to partial nephrectomy, RF is considered a nephron-sparing procedure. Nonetheless, during partial nephrectomy occlusion of the renal hilum is often required, which may cause damage to the remaining parenchyma. Likewise, there are reports of tissue damage beyond the area of RF ablation. The objective of this study is to evaluate the morphological changes of swine kidneys submitted to RF ablation and to compare them to kidneys submitted to warm ischemia. Twenty-six male pigs were divided in three groups. Eight animals were allocated in the sham group which was submitted to laparoscopic dissection of the left renal hilum. Eight animals were allocated in the ischemia group, and under laparoscopic access, had the left renal hilum clamped for 30 minutes. Ten animals were submitted to RF of the lower pole of the left kidney, under visualization through laparoscopy. Blood samples for creatinine mesurement were collected preoperatively, 10 and 21 days postoperatively. Animals were submitted to euthanasia after 21 days, kidneys were collected and weighted. The volume of the kidneys were assessed by the Scherle smethod. The Cavalieri s principle was used to assess the RF volume and sphericity was calculated to assess RF shape. Fragments of RF region and of the upper pole (far from the RF site) were processed for histological evaluation with H&E. Right kidneys were used as self controls for each animal. Glomerular volumetric density (Vv[glom]); volume-weighted glomerular volume (VWGV); and glomerular density were quantified by stereological methods and compared by Student´s-t-test and one-way-ANOVA. One sample t test was used to compare RF volume and shape to hypothetical values of a sphere. Three animals in the RF group developed postoperative complications and were excluded from the analysis. There was no difference in creatinine, mass and volume of the kidneys. The kidneys submitted to RF and warm ischemia for 30 minutes showed lower Vv [glom] and glomerular density when compared to their controls (right kidney) and, when compared to sham animals (p <0.05). The macroscopic lesion caused by RF occurred with the expected volume, but its shape was not similar to that of a sphere. Radiofrequency ablation also determined a significant reduction in glomerular density in the remaining parenchyma. This change was comparable to that observed in kidneys submitted to 30 minutes of warm ischemia.