FEATURES OF COMPENSATOR-ADAPTIVE PROCESSES IN INJURY OF A SINGLE KIDNEY

Pivtorak V.I., Monastyrskiy V.M., Polonevych S.V., Pivtorak K.V., Bulko M.P.

LITERATURE REVIEWS

Scentific article

This paper analyzes the current scientific literature on the pathogenesis of single kidney injury. The classification of blunt kidney injury according to the recommendations of the American Surgical Trauma Association and the classification of blunt kidney injury proposed by Ukrainian scientists are presented. Particular attention was paid to the morphometric analysis of the renal corpuscles of the acquired single kidney in the experiment. Submicroscopic studies of the cortical substance of a single kidney of animals after contralateral nephrectomy showed that in the early stages of the experiment adaptive-compensatory processes are manifested by compensatory hypertrophy of the structural components of the nephrons and reorganization of the vascular bed. In the later stages of the experiment with prolonged functional load on a single kidney, some nephrons develop morphofunctional changes of a destructive nature. Accumulated data suggest that mitochondrial dysfunction plays a crucial role in the pathogenesis of acute renal injury. The analysis of the cell cycle of the cortical cells of a single kidney of adult rats indicates an increase in proliferation and renewal activity in the immediate postoperative period after nephrectomy, which explains the increase in kidney mass and volume. The adaptive phenomenon occurs in a single kidney due to a decrease in the number of nephrons. In the case of a single kidney injury, it is important to establish a change in the topographic and anatomical position of the single kidney. The effectiveness of the transition from surgical treatment of blunt traumatic kidney injuries to conservative treatment in the last decade has been confirmed by a systematic review and meta-analysis. The main mistakes in providing surgical care for gunshot wounds of the genitourinary system are insufficient secondary examination and application of primary sutures after the primary surgical treatment without the necessary indications. It has been established that complications of a single kidney after the opposite nephrectomy are chronic pyelonephritis, nephrogenic hypertension, chronic renal failure, which has progressed over time, nephrosclerosis.

single kidney, trauma, treatment, complications.

1. Craigie RJ, Farrelly PJ, Santos R, Smith SR, Pollard JS, Jones DJ. Manchester Arena bombing: lessons learnt from a mass casualty incident. BMJ Mil Health. 2020;166(2):72–5. DOI: 10.1136/jramc‑2018–000930.
2. Khoschnau S, Jabbour G, Al-Hassani A, El-Menyar A, Abdelrahman H, Afifi I, et al. Traumatic Kidney Injury: An Observational Descriptive Study. Urol Int. 2020;104(1–2):148–155. DOI: 10.1159/000504895.
3. McArdle Z, Schreuder MF, Moritz KM, Denton KM, Singh RR. Physiology and Pathophysiology of Compensatory Adaptations of a Solitary Functioning Kidney. Front Physiol. 2020;11:725. DOI: 10.3389/fphys.2020. 00725.
4. Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, et al. Risk of end-stage renal disease following live kidney donation. JAMA. 2014;311(6):579–86. DOI: 10.1001/jama.2013.285141.
5. Mjøen G, Hallan S, Hartmann A, Foss A, Midtvedt K, Øyen O, et al. Long-term risks for kidney donors. Kidney Int. 2014;86(1):162–7. DOI: 10.1038/ki.2013.460.
6. Erlich T, Kitrey ND. Renal trauma: the current best practice. Ther Adv Urol. 2018;10(10):295–303. DOI: 10.1177/1756287218785828.
7. Keilberth MP, Niclas C, Sparwasser C. Nierentrauma – Diagnose und Therapie aktuell. Therapie. 2014;58(2):68–73.
8. Banyra OB, Stroi OO, Sabadash MIe, Shuliak OV. Zakryta travma nyrky: aspekty diahnostyky ta likuvannia. Ukrainskyi medychnyi chasopys. 2012;(4):127–132. [in Ukrainian].
9. Sarang B, Raykar N, Gadgil A, Mishra G, Wärnberg MG, Rattan A, et al; Towards Improved Trauma Care Outcomes TITCO-India. Outcomes of Renal Trauma in Indian Urban Tertiary Healthcare Centres: A Multicentre Cohort Study. World J Surg. 2021;45(12):3567–3574. DOI: 10.1007/s00268–021–06293-z.
10. Westland R, Schreuder MF, van Goudoever JB, Sanna-Cherchi S, van Wijk JA. Clinical implications of the solitary functioning kidney. Clin J Am Soc Nephrol. 2014;9(5):978–86. DOI: 10.2215/CJN.08900813.
11. Kim S, Chang Y, Lee YR, Jung HS, Hyun YY, Lee KB, et al. Solitary kidney and risk of chronic kidney disease. Eur J Epidemiol. 2019;34(9):879–88. DOI: 10.1007/s10654–019–00520–7.
12. Mavinkurve-Groothuis AM, van de Kracht F, Westland R, van Wijk JAE, Loonen JJ, Schreuder MF. Long-term follow-up of blood pressure and glomerular filtration rate in patients with a solitary functioning kidney: a comparison between Wilms tumor survivors and nephrectomy for other reasons. Pediatr. Nephrol. 2016;31(1):435–41. DOI: 10.1007/s00467–015–3215–2.
13. Tantisattamo E, Dafoe DC, Reddy UG, Ichii H, Rhee CM, Streja E, et al. Current Management of Patients With Acquired Solitary Kidney. Kidney Int Rep. 2019;4(9):1205–1218. DOI: 10.1016/j.ekir.2019.07.001.
14. Monastyrskyi VM, Pivtorak VI. Ultrastrukturni zminy podotsytiv yedynoi nyrky pislia vydalennia kontrlateralnoi. Klinichna anatomiia ta operatyvna khirurhiia. 2015;14(2):33–7. Dostupno: http://nbuv.gov.ua/UJRN/kaoch_ 2015_14_2_9. [in Ukrainian].
15. Su MYM, Huang KH, Chang CC, Wu VC, Wu WC, Liu KL, et al. MRI evaluation of the adaptive response of the contralateral kidney following nephrectomy in patients with renal cell carcinoma. Journal of Magnetic Resonance Imaging. 2015;41(3):822–8. DOI: 10.1002/jmri.24596.
16. Gluhovschi G, Gadalean F, Gluhovschi C, Petrica L, Velciov S, Gluhovschi A, et al. The solitary kidney – a nephrological perspective. Rom J Intern Med. 2013;51(2):80–8.
17. Monastyrskyi VM, Pivtorak VI. Morfofunktsionalnyi stan yedynoi nyrky, shcho zalyshylasia pislia nefrektomii kontralateralnoi (ohliad literatury ta vlasni doslidzhennia). Visnyk Vinnytskoho natsionalnoho medychnoho universytetu im. M.I. Pyrohova. 2018;22(4):743– 51. DOI: https://doi.org/10. 31393/reports-vnmedical‑2018–22(4)-30. [in Ukrainian].
18. Kosiak M, Stefanowicz J, Adamkiewicz-Drożyńska E, Balcerska A, Kurylak A, Demidowicz E. Sonographic Image of Solitary Kidney in Wilms Tumour Survivors. Kidney Blood Press Res. 2018;43:1363–74. DOI: 10.1159/000492951.
19. Basturk T, Koc Y, Ucar Z, Sakaci T, Ahbap E, Kara E, et al. Renal Damage Frequency in Patients with Solitary Kidney and Factors That Affect Progression. Int J Nephrol. 2015;2015:876907. DOI: 10.1155/2015/876907.
20. Monastyrskyi VM, Pivtorak V, Suhodolya SA. Compensatory and adaptive reactions of the single kidney after contralateral nephrectomy. World of medicine and biology. 2018;(3):170–3. DOI: 10.26724/2079–8334–2018–3–65–170–173.
21. Pivtorak VI, Monastyrskyi VM, Okaevich OA, Bulko IV, Smiukha OA. Macroscopic and microscopic status of single kidney and the pyeloureteral segment after contralateral nephrectomy. The World of Medicine and Biology. 2020;1(71):201–205. DOI: 10.26724/2079–8334–2020–1–71–201–205.
22. Pivtorak VI, Monastyrskyi VM. Osoblyvosti strukturnykh komponentiv nefrona kirkovoi rechovyny yedynoi nyrky u nestatevozrilykh shchuriv. Halytskyi likarskyi visnyk. 2015;22(3.2):43–6. Dostupno: http://nbuv.gov. ua/UJRN/glv_2015_22_3 %282 %29__16. [in Ukrainian].
23. Wang X, Johnson AC, Sasser JM, Williams JM, Solberg Woods LC, Garrett MR. Spontaneous one-kidney rats are more susceptible to develop hypertension by DOCA-NaCl and subsequent kidney injury compared with uninephrectomized rats. Am J Physiol Renal Physiol. 2016;310(10): F1054–64. DOI: 10.1152/ajprenal.00555.2015.
24. Wang X, Garrett MR. Nephron number, hypertension, and CKD: physiological and genetic insight from humans and animal models. Physiol Genomics. 2017;49:180–192. DOI: 10.1152/physiolgenomics.00098.2016.
25. Wühl E, van Stralen KJ., Verrina E, Bjerre A, Wanner C, Heaf JG, et al. Timing and outcome of renal replacement therapy in patients with congenital malformations of the kidney and urinary tract. Clinical Journal of the American Society of Nephrology. 2013;8(1):67–74. DOI: 10.2215/CJN. 03310412.
26. Pivtorak VI, Monastyrskyi VM. Elektronno-mikroskopichni zminy yedynoi nyrky, shcho zalyshylasia pislia nefrektomii kontrlateralnoi, u statevonezrilykh shchuriv. Visnyk problem biolohii i medytsyny. 2015;2. 4(121):250–254. Dostupno: http://nbuv.gov.ua/UJRN/ Vpbm_2015_2 %284 %29__58. [in Ukrainian].
27. Kryshtal MV, Hozhenko AI, Sirman VM. Patofiziolohiia nyrok. Odesa: Feniks; 2020. 144 s. [in Ukrainian].
28. Venkatachalam MA, Weinberg JM, Kriz W, Bidani AK. Failed Tubule Recovery, AKI–CKD Transition, and Kidney Disease Progression. J Am Soc Nephrol. 2015;26(8):1765–76. DOI: 10.1681/ASN.2015010006.
29. Andrianova NV, Buyan MI, Zorova LD, Pevzner IB, Popkov VA, Babenko VA, et al. Kidney Cells Regeneration: Dedifferentiation of Tubular Epithelium, Resident Stem Cells and Possible Niches for Renal Progenitors. International Journal of Molecular Sciences. 2019;20(24):6326. DOI: 10.3390/ijms20246326
30. Huling J, Yoo JJ. Comparing adult renal stem cell identification, characterization and applications. Journal of biomedical science. 2017;24(1):32. DOI: doi.org/10.1186/s12929–017–0339–7.
31. Chang-Panesso M, Humphreys BD. Cellular plasticity in kidney injury and repair. Nature Reviews Nephrology. 2017;13(1):39–46. DOI: doi.org/10. 1038/nrneph.2016.169.
32. Huang J, Kong Y, Xie C, Zhou L. Stem/progenitor cell in kidney: characteristics, homing, coordination, and maintenance. Stem Cell Res Ther. 2021;12(1):197. DOI: 10.1186/s13287–021–02266–0.
33. Herashchenko SB, Chaikovskyi YuB, Dieltsova OI. Reheneratsiini mozhlyvosti stovburovykh klityn nyrky. Ukrainskyi zhurnal nefrolohii ta dializu. 2013;4:39–44. [in Ukrainian].
34. Khmara TV, Ryznychuk MA, Slobodian OM. Morfolohichni peredumovy vynyknennia pidkovopodibnoi nyrky. Klinichna anatomiia ta operatyvna khirurhiia. 2015;14(1):81–6. Dostupno: http://nbuv.gov.ua/UJRN/kaoch _2015_14_1_21. [in Ukrainian].
35. Pivtorak VI, Monastyrskyi VM. Zminy klitynnoho tsyklu klityn kirkovoi rechovyny nyrky pislia nefrektomii kontralateralnoi u statevonezrilykh shchuriv. Visnyk problem biolohii i medytsyny. 2016;2.4(129):253–7. Dostupno: http://nbuv.gov.ua/UJRN/ Vpbm_2016_2 %282 %29__57. [in Ukrainian].
36. Zuk A, Bonventre JV. Acute Kidney Injury. Annu Rev Med. 2016;67:293–307. DOI: 10.1146/annurev-med‑050214–013407.
37. MonastirskiyVM,PivtorakVI,FedotovVA.Modelingof possiblemovementsof asinglehumankidney.DeutscherWissenschaftsherold. 2017;(5):31–3. Available from: http://dwherold.de/onewebmedia/2017/5–2017/Monastyrskiy%2031–33.pdf.
38. Pivtorak VI, Monastyrskyi VM. Osoblyvosti topohrafii yedynoi nyrky pislia vydalennia kontralateralnoi. Patolohiia. 2018;2(43):236– 41. DOI: https://doi.org/10.14739/2310–1237.2018.2.141369. [in Ukrainian].
39. Stawicki SP. Trends in nonoperative management of traumatic injuries – A synopsis. Int J Crit Illn Inj Sci. 2017;7(1):38–57. DOI: 10.4103/IJCIIS. IJCIIS_7_17.
40. Mingoli A, La Torre M, Migliori E, Cirillo B, Zambon M, Sapienza P, et al. Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis. Ther Clin Risk Manag. 2017;13:1127–1138. DOI: 10.2147/ TCRM.S 139194.
41.  Aragona F, Pepe P, Patanè D, Malfa P, D’Arrigo L, Pennisi M. Management of severe blunt renal trauma in adult patients: a 10-year retrospective review from an emergency hospital. BJU Int. 2012;110(5):744–8. DOI: 10.1111/j.1464–410X.2011.10901.x.
42. Lanchon C, Fiard G, Arnoux V, Descotes JL, Rambeaud JJ, Terrier N, et al. High Grade Blunt Renal Trauma: Predictors of Surgery and Long-Term Outcomes of Conservative Management. A Prospective Single Center Study. J Urol. 2016;195(1):106–11. DOI: 10.1016/j.juro.2015.07.100.
43. Bjurlin MA, Fantus RJ, Villines D. Comparison of nonoperative and surgical management of renal trauma: can we predict when nonoperative management fails? J Trauma Acute Care Surg. 2017;82:356–361.
44. Kyu HH, Bachman VF, Alexander LT, Mumford JE, Afshin A, Estep K, et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ. 2016;354: i3857. DOI: 10.1136/bmj.i3857.
45. Kitrey ND, Djakovic N, Kuehhas FE, Lumen N, Serafetinidis SD. EAU guidelines on urological trauma. European Association of Urology; 2017. 67 p.
46. Karn M, Kandel D, Mahato BK, Thapa S, Kc HB. Urinoma following blunt renal trauma in a patient with anomalous solitary kidney: A case report. Int J Surg Case Rep. 2021;86:106386. DOI: 10.1016/j.ijscr.2021.106386.
47. Coccolini F, Moore EE, Kluger Y, Biffl W, Leppaniemi A, Matsumura Y, et al. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg. 2019;14:54. DOI: 10.1186/s13017–019–0274-x.
48. Yeung LL, Brandes SB. Contemporary management of renal trauma: differences between urologists and trauma surgeons. J Trauma Acute Care Surg. 2012;72(1):68–75; DOI: 10.1097/TA.0b013e31823e29f6.
49. Holovko SV. Suchasna boiova travma orhaniv sechostatevoi systemy. Zdorovia Ukrainy. Tematychnyi nomer Urolohiia. Nefrolohiia. Androlohiia. 2021;2(23):29. [in Ukrainian].

«Bulletin of problems biology and medicine» Issue 2 Part 1 (164), 2022 year, 55-67 pages, index UDK 612.46:616.61–089.878:611

10.29254/2077-4214-2022-2-1-164-55-67