L igation of the left renal vein in epm l-w istar rats: functional
and m orphologic alterations in the kidneys,
testes and suprarenal glands
Escola Paulista de Medicina - Universidade Federal de São Paulo (EPM-UNIFESP)
- São Paulo, Brazil
Objective: The Iigation of the left renal vein (LLVR) in man is a contraversial procedure in view of the risks of lesion to the renal parenchyma. W ith the objecUve of studying the morphologic and functional alterations caused by these lesions, we conducted experimental research with rats. Material and Methods: 64 male adult EPM 1-W ISTAR rats were used, divided into 8 groups - 4 for . LLRV and four for control. Each LLRV group and corresponding control group were sacrificed progressively on the 7th, 15th, 30th and 60th day after the initial surgery. Results: W e found morphofunctional alterations only in animais that underwent LLRV in the four periods of sacrifice. The proteinuria creatinine in serum, testosterone in serum and serum corticosterone in serum showed practically no alteration in relation to the normal values for rats. Statistically significant severe histological lesions were found in the kidneys and testes of the LLRV groups. Lesions in the suprarenal glands were also presentin these groups, but no sufficient to demonstrate statistical significance Conclusion: Based on these results we can conclude that the Iigation of the left renal vein is a procedure of high risk in these animais.
Uniterms: Renal Veins. Ligation. Kidneys. Testes. Suprarenal glands.
INTRODUCTION
P
situ a tió nre q u e n tly ,in re la tio nth e su rg e o nto n o rm a l h u m a n a n a to m y .fin d s h im se lf in a d iffic u ltD u e to th e sy n tro p y o f th e e le m e n ts o f th e h u m a n b o d y , a g o o d su rg ic a l a p p ro a c h to a c e rta in o rg a n o r se g m e n t .o fth e b o d y c a n so m e tim e s c a u se d a m a g e to a n o th e r e le m e n t
w ith sig n ific a n t re p e rc u ssio n s. T h e le ft re n a l v e in (L R V )
d u e to its sy n tro p y w ith th e a b d o m in a l a o rta , m a y h a m p e r a n id e a l a p p ro a c h to th a t a rte ry .l
A d rre s s fo r c o rre s p o n d e n c e : J o s é C a rlo s C o s ta B a p tis ta -S ilv a
R u a P ro f. A rtu r R a m o s , 178,a p to 123 V e g a S ã o P a u lo /S P - B ra s il- C E P 0 1 4 5 4 -9 0 4
A s th e L R V h a s m a n y trib u ta rie s, m a n y a u th o rs
re c o m m e n d its lig a tio n o r te m p o ra ry se c tio n to fa c ilita te th e
su rg ic a l p ro c e d u re .2 -2 7 H o w e v e r, in th e c a se o f th e rig h t re n a l v e in (R R V ) w h ic h h a s n o trib u ta rie s, its lig a ta tio n w ill
c e rta in 1 y re su lt in se v e re re n a lle sio n , a n d c o n se q u e n tly th is
p ro c e d u re is fo rb id d e n .2 8 -3 2 T h e p re se n c e o f m u lti p Ie r~ n a l
v e in s is m o st fre q u e n t o n th e rig h t, w h ic h is sh o rte r, d ra in s
in to th e c a v a a n d h a s n o re la tio n sh ip to th e a o rta . T h e L R V is
n o rm a l1 y u n iq u e , lo n g e r, a n d c ro sse s tra n sv e rsa lly in fro n t o f
th e a o rta b e fo re d ra in in g in to th e in fe rio r v e n a c a v a a n d
g e n e ra lly re c e iv e s th re e trib u ta rie s.2 8 -5 2
M a n y c o m p lic a tio n s h a v e b e e n p u b lish e d a fte r th e
lig a tio n o f th e le ft re n a l v e in (L L R V ), in c lu d in g lo ss o f th e
re n a l fu n c tio n re q u irin g h e m o d ia ly sis, re tro p e rito n e a l
h e m o rrh a g e , in c re a se in c re a tin in e le v e Is, c o n g e stio n o f th e
re n a l v e in , re n a l n e c ro sis, ru p tu re o f th e le ft k id n e y , th u s in c re a sin g th e p a tie n t' s m o rb id ity .2 ,9 ,1 0 ,1 1 ,1 4 ,3 4 ,4 4 ,5 3 -7 0T o a v o id re n a l c o m p lic a tio n s7 1 -7 4re a n a sto m o sis h a s b e e n re c o m m e n d e d
BAPTISTA-SILVA,J.C.C.; DOLNIKOFF,M.S.; MOURA, L.A.R. et aI. - Ligation of the left renal vein in epm1-wistar rats: functional and morphologic alterations in the kidneys,
testes and suprarenal glands
1 4 7 6
T a b le 1
D is tr ib u tio n o f th e r a ts p e r g r o u p , ty p e o f p r o c e d u r e a n d s a c r ific e d a y
T h e ra ts w e re id e n tifie d fro m 1 to 6 4 . " IN IT IA L "
re fe rre d to th e firs t d a y o f s u rg e ry a n d " S A C R IF IC E " to .
th e la s t d a y o f th e e x p e rie n c e . (T a b le 1 ).
T h e a n im a Is w e re s u b m itte d to a n e s th e s ia b y
in h a la tio n o f e th y l e th e r. A m e d ia n u s la p a ro to m y o f a b o u t
3 c m w a s p e rfo rm e d , w ith d e v ia tio n o fth e in te s tin a llo o p s
to th e rig h t, o p e n in g o f th e re tro p e rito n e a l a n d c a re fu l
d is s e c tio n o f th e s tru c tu re s a n d lig a tu re o f th e le ft re n a l
v e in c lo s e to th e in fe rio r v e n a c a v a , w ith a 7 -0
m o n o fila m e n t p o ly p ro p y le n e th re a d , p re s e rv in g th e re n a l
d ra in a g e to th e s u p ra re n a l, te s tic u la r a n d re n o lu m b a r v e in s .
C lo s u re o f th e a b d o m in a l w a ll w a s p e rfo rm e d u s in g a 3 -0
c o tto n th re a d . A la p a ro to m y w a s p e rfo rm e d in th e c o n tro I
g ro u p , a s w e ll a s d is s e c tio n o f th e L R V ; th re a d in g a n d
w ith d ra w a l o f a m o n o fila m e n t p o ly p ro p y le n e 7 -0 th re a d
u n d e r th e . L R V w a s c o n d u c te d w ith o u t lig a tio n . T h e
a n im ~ ls w e re w e ig h e d b e fo re s u rg e ry a n d a fte r s a c rific e
a n d w e re a lw a y s s a c rific e d b y d e c a p ita tio n b e tw e e n 1 0
a n d 1 2 h rs . T h e a n im a Is w e re b e h e a d e d a n d th e b lo o d
c o lle c te d fro m th e n e c k v e s s e ls p la c e d in h e p a rin iz e d tu b e s
a n d s e n t fo r b io c h e m ic a l a n a ly s is . A fte r th e b e h e a d in g a n d
c o lle c tin g o f b lo o d , th e a n im a Is w e re s u b m itte d to
x ip h o p u b ic la p a ro to m y , a s s e s s m e n t o f th e a b d o m in a l
c o n d itio n ,. a c c u ra te e x a m o f th e in tra a n d re tro p e rito n e a l
o rg a n s . T h e k id n e y s , te s te s a n d s u p ra re n a l g la n d s w e re
e x a m in e d , w ith d ra w n a n d w e ig h e d (h u m id w e ig h t), a n d
s u b m itte d to h is to lo g ic a l a n a ly s is b y lig h t m ic ro s c o p y .
S ta tis tic a l a n a ly s i\s o f th e c re a tin in e , te s to s te ro n e ,
s e ru m c o rtic o s te ro n e a n d p ro te in u ria w a s o b ta in e d b y
m e a n s o f a n e x p e rim e n ta l p lé } nw ith tw o fa c to rs a s s a c rific e
d a te w ith fo u r le v e Is (7 th , 1 5 th , 3 0 th a n d 6 0 th d a y ) a n d
s u rg e ry w ith tw o le v e Is , lig a tio n a n d c o n tro l, a n d th e ir
v a lu e s b y v a ria n c e a n a ly s is fo r a n h ie ra rc h ic a l m o d e l.1 1 9
T h e re s u lts o f p e rc e n tu a l v a ria tio n b e tw e e n th e w e ig h t o f
th e a n im a Is . a n d th e ir k id n e y s , te s te s a n d s u p ra re n a l g la n d a s a ro u tin e a fte r th e s e c tio n o f th e L R V . T h e b lo o d flo w to
a n o rg a n d e tre a s e s w h e n th e v e n o u s p re s s u re n e a rs th e
d ia s to lic b lo o d p re s s u re .7 5 ,7 6T h e L L R V e n a b le s th e in v e rs io n
o f th e v e n o u s flo w a n d v e n o u s h y p e rte n s io n in th e k id n e y , te s te s a n d s u p ra re n a l g la n d .8 , 1 4 ,2 1 ,5 0 ,6 0 ,6 7 ,7 1 -8 9
B a p tis ta -S ilv a (1 9 9 4 )1 in m o re th a n 2 0 0 s u rg e rie s o f
th e a o rta , n e v e r h a d th e n e e d to p e rfo rm a lig a tu re o f ·
L R V in e le c tiv e s u rg e ry s u c h a s a n e u ry s m e m e rg e n c ie s
o r tra u m a to th e a o rta . In o th e r w o rd s , w h e n th e a p p ro a c h
to th e a o rta w a s d iffic u lt, h e u s e d o th e r s u rg i c a l te c h n iq u e s
re c o m m e n d e d b y o th e r a u th o rs ,3 9 , 5 3 ,6 9 ,7 1 ,7 2 ,8 7 ,8 8 ,9 0 -1 0 3to
fa c ilita te th e d is s e c tio n o f th e a o rta a n d a v o id a L L R V .
M a n y re s e a rc h e rs , w o rrie d a b o u t th e c o m p lic a tio n s o f
L L R V a n d re n a l v e in th ro m b o s is , a n d in te re s te d in
in v e s tig a tin g v a ric o c e le d e v e lo p e d e x p e rim e n ta l m o d e ls in
a n im a ls w ith s im ila r c lin ic ':ll fin d in g s . D o g s a n d ra ts w e re
u s e d in th e s e s tu d ie s d u e to th e s im ila rity o f th e ir v a s c u la r
a n a to m y , h e m o d y n a m ic re p e rc u s s io n a n d im m u n o lo g y
s y s te m to th a t o f m a n o 1 1 .w a s d e m o n s tra te d th a t in d o g s a L L R V in c re a s e d 2 0 tim e s th e h ila r re n a l v e n o u s p re s s u re ,
re d u c in g th e re n a l a rte ria l p re s s u re , th e th ic k e n in g o f th e b a s a l
re n a l m e m b ra n e , th e h ig h c o n c e n tra tio n o f n e p h ro to x ic s
a n tig e n , p ro te in u ria , h y p o p ro te in e m ia , h y p o a lb u m in e m ia ,
h y p e rc h o le s te ro le m ia , a tro p h y o f th e le ft k id n e y , a rte ria l
h y p e rte n s io n in th e k id n e y s w ith re n a l c o n g e s tio n , re a c tio n
to im m u n o c o m p le x w ith le s io n o f th e rig h t k id n e y a n d
in c re a s e in m o rta lity o f a n im a lS .4 7 ,7 5 ,7 6 ,8 3 ,1 0 4 -1 1 7
B a s e d o n th e c u rre n t c o n tro v e rs y in re la tio n to re n a l
le s io n , a n d in th e a b s e n c e o f lite ra tu re o n th e in c id e n c e o f
le s io n to th e te s te s a n d s u p ra re n a l g la n d s a fte r th e lig a tu re
o f th e le ft re n a l v e in in m a n , w e d e c id e d to re s e a rc h in
ra ts th e fu n c tio n a l a n d h is to p a th o lo g ic a lte ra tio n s c a u s e d
b y th e L L R V in th e k id n e y s , te s te s a n d s u p ra re n a l g la n d s .
M A T E R IA L A N D M E T H O D S
S ix ty fo u r m a le a d u lt E P .M 1 -W IS T A R ra ts w e re
u s e d , w e ig h in g a ro u n d 2 6 4 to 4 6 9 g ra m s , a n d w e re
m a in ta in e d u n d e r c o n tro lle d lig h t c o n d itio n s fro m 6 A .M .
to 6 P .M . a n d d a rk n e s s fro m 6 P .M . to 6 A .M ., a t ro o m
te m p e ra tu re o f 2 4 :t 1 ° C a n d fre e a c c e s s to ra t ra tio n a n d
w a te r (1 ,1 1 8 ). T h e ra ts w e re ra n d o m iz e d in to 8 e q u a l
g ro u p s (8 a n im a Is e a c h ) - fo u r g ro u p s fo r lig a tio n o f th e
le ft re n a l v e in a n d fo u r c o n tro l g ro u p s . T h e g ro u p s w e re
ra n d o m ly c h o s e n to b e s a c rific e d o n th e 7 th , 1 5 th 3 0 th
a n d 6 0 th d a y a fte r in itia l s u rg e ry , a lw a y s in c lu d in g o n e
fro m th e L IG A T U R E g ro u p (L 7 , L 1 5 , L 3 0 , L 6 0 ) a n d
o n e fro m th e C O N T R O L g ro u p (C 7 , C 1 5 , C 3 0 , C 6 0 ).
G r o u p s
L 7
C 7 L 1 5
C 1 5 L 3 0 C 3 0 L 6 0 C 6 0
N Q o f R a ts
8 { 1
a
8 } 8 { 9a
1 6 } 8 { 1 7a
2 4 } 8 { 2 5a
3 2 } 8 { 3 3a
4 0 }8 { 4 1
a
4 8 } 8 { 4 9 a 5 6 }8 { 5 7
a
6 4 }T y p e o f P r o c e d u r e
" Iig a tio n " " c o n tr o l"
" Iig a tio n " " c o n tr o l"
" Iig a tio n " " c o n tr o l" " Iig a tio n "
" c o n tr o l"
S a c r ific e d a y
7 th
7 th 1 5 th
1 5 th 3 0 th
3 0 th 6 0 th 6 0 th
S ã o P a u lo M e d ic a i J o u r n a V R P M 1 1 5 ( 4 ) : 1 4 7 5 - 1 4 8 4 , 1 9 9 7 B A P T IS T A - S IL V A ,J .C .C .; D O L N IK O F F ,M .S .; M O U R A , L .A .R . e t a I. - L ig a tio n o f th e le ft r e n a l v e in in e p m 1 - w is ta r r a ts : fu n c tio n a l a n d m o r p h o lo g ic a lte r a tio n s in th e k id n e y s ,
w e r e a n a ly z e d u s in g S T U D E N T
t
te s tl2 0; th e
h is to p a th o lo g ic a l r e s u lts w e r e a n a ly z e d u s in g F I S H E R 's
e x a c t te s t.1 2 1 T h e s ig n if ic a n t v a lu e s w e r e m a r k e d w ith a n
a s te r is k ( * ) . T h e te s ts w e r e p e r f o r m e d a t a 5 % ( p < 0 .0 5 )
le v e I o f s ig n if ic a n c e .
R E S U L T S
T h e e x a m in a tio n o f th e a b d o m in a l w a ll o f th e r a ts
s h o w e d g o o d c ic a tr iz a tio n a n d n o in f e c tio n w a s d e te c te d .
A lI th e r a ts o f th e lig a tu r e a n d c o n tr o l g r o u p s w e r e
s u b m itte d to a n e x a m o f th e in tr a p e r ito n e a l c a v ity a n d n o
v is c e r a l a b n o r m a lie s w e r e f o u n d . T h e a lte r a tio n s o b s e r v e d
in th e r e tr o p e r ito n e u m w e r e r e la te d to th e s iz e a n d c o lo r o f
th e k id n e y s a ild s u p r a r e n a l g la n d s a n d m a in v e in s a n d
tr ib u ta r ie s . N o th r o m b o s is o f th e r e n a l v e s s e ls a n d tr ib u ta r ie s
w a s o b s e r v e d e ith e r in th e lig a tio n o r c o n tr o l g r o u p s .
T h e le f t k id n e y s o f lig a tio n s . w e r e s w o lle n a n d h a d a
v io le t c o lo r in g b y d a y 7 a n d 1 5 , b u t o n d a y 3 0 th e y h a d r e d u c e d
in s iz e a n d w e r e " m o r e c y a n o tic . O n th e 6 0 th d a y th e r e d u c tio n
in s iz e w a s m o r e a p p a r e n t a n d th e c o lo r in g w a s d a r k e r w ith
th e le f t k id n e y s h o w in g a n in c r e a s e in s iz e . T h e lig a tio n s o f
th e L R V a n d th e ir tr ib u ta r ie s w e r e a lw a y s d ila te d .
T h e te s te s o f lig a tio n g r o u p s , to th e le f t, th e v e n o u s
n e tw o r k w a s d ila te d ; o n th e 6 0 th d a y th e le f t te s tis w a s
a lw a y s s m a lle r th a n th e " r ig h t o n e .
T h e s u p r a r e n a l g la n d s w e r e to a s m a ll f o r th e
o b s e r v a tio n o f m a c r o s c o p ic d if f e r e n c e s b e tw e e n th e m .
T h e s u p r a r e n a l v e n o u s n e tw o r k to th e le f t o f th e lig a tio n
w a s e n la r g e d c o m p a r e d to th e c o n tr o I . ( F ig 1 , T a b le 2 )
T h e r e s u lts o f th e p r o te in u r ia , s e r u m c r e a tin in e ,
s e r u m te s to s te r o n e a n d s e r u m c o r tic o s te r o n e w e r e
s ta tis tic a lly d if f e r e n t in s o m e p e r io d s o f th e c o n tr o ls b u t
d id n o t e x c e e d th e v a lu e s o f n o r m a lity f o r r a ts .
H IS T O P A T H O L O G Y C H A N G E S B Y L IG H T
M IC R O S C O P Y
Kidneys
I n th e lig a tu r e g r o u p s , w e f o u n d s e v e r e le s io n s d u e
to is c h e m ia , c la s s if ie d a s a tr o p h y o f th e p a r e n c h y m a ,
p a p illa n e c r o s is , le s io n o f th e d is ta I tu b u li, s e v e r e is c h e m ia ,
in f a r c tio n a n d n e c r o s is o f th e k id n e y s o f th e r a ts s a c r if ic e d
la b le 2
A b s o lu te re s u lts o fW E IG H T : B o d y (in itia l a n d s a c rific e ), o f th e K id n e y s , T e s te s a n d S u p ra re n a l g la n d s .
B IO C H E M IC A L E X A M S : P ro te in u ria , S e ru m C re a tin in e , S e ru m T e s to s te ro n e , S e ru m C o rtic o s te ro n e . G R O U P S :
L = L ig a tu re , C = C o n tro l; a n d 7 , 1 5 ,3 0 e 6 0 re fe r to th e s a c rific e d a y . M E A N a n d S O (S ta n d a rd O e v ia tio n ).
G ro u p s W e ig h t (g ) B io c h e m ic a l E x a m s
B O O y K id n e y T e s tis 8 L p a re n a J a e a tin e p ro te in u ria te s to te ro n e o o rtic n s te ro n e
In itia l S a c rific e R ig h t L e ft R ig h t L e ft R ig h t L e ft m g /d l m g /2 4 h 1 1 9 /d l J lg /d l
L 7 M e a n 2 8 9 .8 8 2 8 0 .0 0 * 1 .1 5 8 1 .3 2 4 1 .3 7 5 1 .4 8 7 0 .0 3 0 0 .0 3 4 0 5 0 0 * 1 1 .8 2 8 * 8 7 .1 2 5 * 7 .5 4 9 *
SO
2 4 .1 7 5 2 3 .5 6 8 0 .1 5 3 0 .4 7 9 0 .2 8 2 0 .2 3 2 0 ." 0 0 4 0 .0 0 6 0 ..0 5 3 1 .9 9 4 3 3 .9 8 9 3 .2 5 3 C 7 M e a n 2 7 6 .8 8 2 7 3 .7 5 1 .0 7 1 1 .0 7 0 1 .5 0 0 1 .4 4 9 0 .0 2 7 0 .0 3 0 0 .3 7 5 9 .0 8 6 1 4 2 .3 7 5 3 .3 2 8so
1 9 .6 2 8 2 1 .2 1 8 0 .1 0 1 0 .0 9 9 0 .0 7 4 0 .0 9 4 0 .0 0 7 0 .0 0 8 0 .0 4 6 1 .5 4 0 4 5 .0 7 4 2 .2 4 6L 1 5 M e a n 2 9 0 .0 0 2 9 4 .5 0 * 1 .2 3 4 * 1 .4 5 5 * 1 .4 1 3 1 .3 9 9 0 .0 2 8 0 .0 2 8 0 .4 8 8 * 1 2 . 1 0 3 * 1 2 6 .3 7 5 8 .2 3 1
SO
2 5 .3 5 5 2 6 .5 3 3 0 .1 .4 6 0 .3 5 7 0 .3 4 4 0 .3 5 8 0 .0 0 5 0 .0 0 6 0 .0 3 5 3 .2 0 3 5 0 .6 2 2 5 .2 5 7 C 1 5 M e a n 2 8 1 .6 3 2 9 2 .2 5 1 .0 8 3 1 .0 6 4 1 .5 3 4 1 .5 5 0 0 .0 2 5 0 .0 2 5 0 .4 1 3 8 .3 1 3 1 0 8 .6 2 5 5 .9 0 4SO
2 8 .9 4 8 2 9 .6 8 8 0 .1 5 0 0 .1 4 9 0 .1 2 2 0 .1 2 6 0 .0 0 5 0 .0 0 6 0 .0 6 4 1 .8 8 1 2 2 .2 0 6 2 .1 2 3 L 3 0 M e a n 2 8 8 .0 0 3 0 0 .7 5 1 .1 0 3 1 .0 2 1 1 .4 1 8 1 .4 3 6 0 .0 3 0 * 0 .0 3 1 * 0 .4 3 8 1 4 .3 2 8 * 1 1 5 .0 0 0 1 0 .1 2 9SO
2 0 .2 2 7 1 9 .2 4 1 0 .1 1 6 0 .2 1 4 0 .2 2 6 0 .1 8 8 0 .0 0 6 0 .0 0 8 0 .0 5 2 4 .0 1 2 3 " 3 3 .7 8 5 4 .5 8 3 C 3 0 M e a n 3 1 7 .0 0 3 2 6 .5 0 1 .0 9 6 1 .1 2 2 1 .5 2 3 1 .5 5 6 0 .0 2 5 0 .0 2 4 0 .4 0 0 8 .8 4 0 1 2 9 .3 7 5 8 .2 8 0SO
1 1 .2 2 5 1 2 .3 0 6 0 .0 8 3 0 .1 0 8 0 .0 9 3 0 .0 7 7 0 .0 0 3 0 .0 0 4 0 .0 9 3 1 .5 8 4 1 1 0 .2 2 5 4 .6 1 5 L 6 0 M e a n 3 1 5 .5 0 3 3 1 .8 8 * 1 .4 4 1 * 0 .5 7 6 * 1 .4 5 9 1 .2 4 3 * 0 .0 2 6 0 .0 2 7 0 .3 6 3 * 1 4 .2 8 3 * 1 1 7 .9 0 0 7 .6 5 0SO
3 4 .4 2 2 4 4 .3 1 5 0 .2 1 6 0 .2 9 6 0 .3 7 4 0 .5 1 4 0 .0 0 4 0 .0 0 2 0 .0 5 2 3 .7 0 2 4 4 6 .5 2 2 1 .8 3 4 C 6 0 M e a n 3 0 9 .7 5 3 3 8 .7 5 1 .1 2 4 1 .1 0 9 1 .6 3 8 1 .6 7 8 0 .0 2 4 0 .0 2 3 0 .2 8 8 1 0 .7 2 5 1 4 4 .7 5 0 7 .6 7 6SO
3 3 .2 4 7 3 7 .5 8 3 0 .1 5 2 0 .1 1 2 0 .1 3 1 0 .1 5 4 0 .0 0 6 0 .0 0 4 0 .0 9 9 3 .5 4 4 5 5 0 .8 2 1 1 .9 2 7* p < 0 ,0 5
B A P T IS T A -S IL V A ,J .C .C .; D O L N IK O F F ,M .S .; M O U R A , L .A .R . e t a I. - L ig a tio n o f th e le ft re n a l v e in in e p m 1 -w is ta r ra ts : fu n c tio n a l a n d m o rp h o lo g ic a lte ra tio n s in th e k id n e y s ,
te s te s a n d s u p ra re n a l g la n d s
1478
uRETERS
P A M P I N I F O R M P L E X U S
TESTES
o b s e r v e d o n th e 3 0 th d a y a n d to th e I e f t o n th e 6 0 th d a y , in
r e I a tio n to th e c o n tr o I g r o u p , a n d w e r e m o r e s e v e r e to th e
I e f t th a n to th e r ig h t.
p<
0 ,0 5 ( T a b I e 3 , F ig . 3 )Suprarenal Glands
I n th e lig a tu r e g r o u p s , w e f o u n d s e v e r e I e s io n s d u e
to is c h e m ia , c I a s s if ie d a s c o r tic a I a tr o p h y , m e d u lla r a n d
c o r tic a I n e c r o s is o f th e s u p r a r e n a I . g I a n d s o f th e r a ts
s a c r if ic e d o n th e 7 th , 1 5 th , 3 0 th a n d 6 0 th d a y s a f te r th e
in itia I o p e r a tio n , b u t w ith o u t s ta tis tic a I d if f e r e n c e s in
r e la tio n to th e c o n tr o I g r o u p . ( T a b le 3 ) p > 0 ,0 5 .
Figure 2 - Left kidney of rat# 55 of the Iigature group, show ing alterations of the ischem ic type, difuse, w ith retracted, enlarged m esangial m atrix and tubuli w ith atrophy signs, surrounded by interstitium w ith fibrosis and rare Iym phocyte infiltrates. (H E - 126x)
Figure 1 - Ligature of the left renal vein, seven days after the initial operation. it is show n on the left side the dilatation of follow ing . veins: (enal, suprarenal, testicular, of the pam piniform plexus, of
the ureber .and increase of the kidney.
o n th e 7 th , 1 5 th , 3 0 th a n d 6 0 th d a y s a f te r th e in itia l
o p e r a tio n . T h e y w e r e m o r e s e v e r e to th e le f t th a n to th e
r ig h t. S ta tis tic a l d if f e r e n c e s w e r e o n ly o b s e r v e d o n th e le f t
s id e , in th e lig a tio n g r o u p s , c o m p a r e d w ith th e c o n tr o l
g r o u p s in th e 7 th , 1 5 th , 3 0 th a n d 6 0 th d a y .
p<
0 ,0 5 ( T a b I e .3 , F ig . 2 )
Testes
I n th e lig a tu r e g r o u p s , w e f o u n d s e v e r e le s io n s d u e
to is c h e m ia , c la s s if ie d a s a tr o p h y , n e c r o s is , d if f u s e f ib r o s is
w ith ç a lc if ic a tio n o f th e te s te s o f tJ 1 e r a ts s a c r if ic e d o n th e
7 th , 1 5 th , 3 0 th a n d 6 0 th d a y s a f te r th e in itia l o p e r a tio n .
S ig n if ic a n t s ta tis tic a l b ila te r a l d if f e r e n c e s w e r e o n ly
Figure 3 - Left testis of rat # 38 of the ligature group, show ing diffuse coagulation necrosis. Interstitial inflam m atory exudate is
also presente (H E - 79x)
la b ia 3
R e su lts o f th e h isto p a th o lô g y o f th e 'kid n e ys, te ste s, a n d su p ra re n a l g la n d s. G R O U P S : L
=
L ig a tu re , C=
C o n tra i; a n d 7 ,1 5 ,3 0 e 6 0 re fe r to th e sa crifice d a y.
( *
p
< 0 .0 5 b y F ish e r e xa ct te st )K id n e ys T e ste s 'S u p ra re n a l
G la n d s
G ro u p s H isto p a th o lo g yR ig h t L e ft R ig h t L e ft R ig h t L e ft
L 7 N o rm a l 6 3 6 8 6 7
P a th o lo g ie 2 5 * 2 O 2 1
C 7 N o rm a l ,8 8 8 8 8 8
P a th o lo g ie O O O O O O
L 1 5 N o rm a l 7 O 5 5 7 5
P a th o lo g ie 1 8 * 3 3 1 3
C 1 5 N o rm a l 8 8 8 ,8 8 8
P a th o lo g ie O O O O O O
L 3 0 N o rm a l 7 2 3 2 '6 6
P a th o lo g ie 1 6 * 5 * '6 * 2 2
C 3 0 N o rm a l 8 8 8 8 8 8
P a th o lo g ie O O O O O O
L 6 0 N o rm a l 8 O 6 4 8 6
P a th o lo g ie O 8 * 2 4 * O 2
C 6 0 N o rm a l 8 8 8 8 8 8
P a th o lo g ie O O 'O O O O
D IS C U S S IO N .
In th is stu d y w e fo u n d b io ch em ical, fu n ctio n al an d
h isto lo g ical alteratio n s as a resu lt o f th e' lig atio n o f th e left
ren al v ein . C o n fm n in g p rev io u s sriId ies o n th e su b ject, d ilatio n
o f th e left ren al v ein 'an d its trib u taries w as fo u n d o n ly in th e lig atio n g ro u p s, in all p erio d s.6 1 ,7 5 ,8 6 ,1 0 6 ,1 1 5 ,1 2 2 ,1 2 3
In th e L L R V an im aIs, w e fo u n d a sig n ifican t v ariatio n
o f b o d y w eig h t (less w eig h t in crease co m p ared to th e
co n tro l g ro u p ) o n th e 7 th , 1 5 th an d 6 0 th d ay after th e
in itial o p eratio n . H o w ev er, th is v atiatio n w as' n o t p resen t
w h en o n ly a sten o sis o f th e L R V w as p erfo rm ed .8 6
A t th e en d o f th ~ ex p erim en t h y p ertro p h y w as fo u n d
in th e rig h t k id n ey , an d atro p h y in th e left. T h ese alteratio n s
sh o w ed th at th e rig h t k id n ey in cre~ sed in size b ecau se o f
o v erlo ad , an d th e left k id n ey lo st w eig h t d u e to sev ere
h isto lo g ical in ju ries cau sed b y isch em ia d u e to an
ex ten d en d v en o u s stasis. T h ese resu lts are th e sam e
rep o rted b y o th er au th o rs.2 ,6 1 ,7 5 ,1 2 4 -1 2 7In d o g s su b m itted to
lig atio n o f th e left ren al v ein th ere w as a d ecrease o f b lo o d
flo w o n th e left as a co n seq u en ce o f v en o u s stasis 7 5an d in '
m an th e v ariatio n o f th e p ressu re in th e h ilar ren al v en o u s
stu m p w as d ep en d en t o n th e flo w th ro u g h th e trib u taries
o f th e L R V w ith th e p ressu re ab o v e 6 0 em o f w ater in th e '
h ilar ren al v en o u s stu m p p o ssib ly lead in g to a 'd ecrease o f
th e g lo m eru lar filtratio n d u e to th e d ecrease o f th e ren al
arterial flO W .1 7 ,5 4W e fo u n d an in crease in creatin in e seru m
an d p ro tein u ria in th e lig atu re g ro u p s, alth o u g h th ese
v alu es w ere p ractically n o rm al. L ig h t p ro tein u ria w as
o b serv ed in rats su b m itted to L L R V . M assiv e p ro tein u ria,
su ch as th at o b serv ed in n ep h ro tic sy n d ro m e, w as o n ly
p o ssib le in sev ere ren al in ju ry .1 2 4 It is d ifficu lt to o b tain
m assiv e p ro tein u ria in an ex p erim en tal stu d y .1 2 8 F ailu re to
p ro d u ce m assiv e p ro tein u ria fro m an affected k id n ey o r
n ep h ro tic sy n d ro m e m ay b e p artially d u e to th e in su fficien t
in crease o f th e ren al v en o u s p ressu re. S ig n ifican t
p ro tein u ria o ccu rred o n ly in a d o g w ith h ig h ren al v en o u s
p ressu re (3 0 em o f salin e).1 2 6 In acu te ex p erim en ts W eg ria
et aI 1 2 9fo u n d th at p ro tein w as n o t p resen t in th e u rin e
w h en th e p ressu re in th e left ren al v ein o f th e d o g w as o f
less th an 2 4 ,5 em o f w ater. A p ressu re b etw een 2 4 ,5 an d
4 2 em o f w ater in th e left k id n ey ex creted p ro tein in 1 7 o f
th e 2 7 an im aIs u n d er stu d y . In p ressu res ab o v e 4 2 em o f
w ater, p ro tein u ria w as p ractically alw ay s p resen t.1 2 9 In d o g s
th e p ressu re o f th e left ren al v ein after lig atu re v aried
b etw een 1 4 an d 3 0 em o f w ater, an d w as n o t asso ciated
w ith sig n ifiean t p ro tein u ria fro m eith er th e affected o r
th e co n tro l k id n ey .1 2 6 In th e h isto ~ o g ical an aly sis w e
o b serv ed th at th e k id n ey s h ad a sev ere lesio n d u e to d iffu se
isch em ia, atro p h y o f th e p aren ch y m a, n ecro sis o f p ap illa,
in farctio n an d fib ro sis in atl g ro u p s o f lig atio n esp ecially
in th e left k id n ey , w ith th e b io ch em ical alteratio n s (seru m
creatin ih e an d p ro tein u ria) rem ain in g n ear th e lim its o f
n o rm ality fo r rats. H isto lo g ical alteratio n s w ere related to
an in crease in p ro tein d ro p lets in th e tu b u lar cells,
leu k o cy te m arg in atio n in th e g lo m eru lar cap illaries, an d
th ick en in g o f th e g lo m eru lar m em b ran e.1 2 6 T h is sh o w ed
th at in th e case o f L L R V b io ch em ical an aly sis alo n e is n o t
su fficien t to u n co v er a ren allesio n as alread y rep o rted in
m ed icalliteratu re.6 1 ,7 5 ,1 1 4 ,1 2 4 ,1 2 5 ,1 2 7 ,1 3 oO u r resu lts sh o w ed th at
ren al lesio n s w ere p red o m in an tly o n th e left sid e in all
p erio d s. N ev erth eless, lesio n s o n th e rig h t sid e w ere
p resen t o n ly in th e lig atu re g ro u p s su g g estin g th at th ere
are o th er faeto rs eo n trib u tin g to a lesio n in th e rig h t k id n ey .
T h is co u ld p o ssib ly b e d u e to an im m u n o co m p lex reactio n
as a resu lt o f an in ju ry to th e left k id n ey , sim ilar to th at
d escrib ed b y o th er in v estig ato rs. 7 5 ,1 1 0
In th e testes, atro p h y w as fo u n d o n th e left o n th e 6 0 th
d ay , a fin d in g alread y d escrib ed in ex p erim en tal sten o sis o f
L R V .8 6T h ere w as p ractically n o v ariatio n o f th e seru m
testo stero n e lev eI th ro u g h o u t th e p erio d s. S im ilar altératio n
o f th e seru m testo stero n e lev eI w as rep o rted b y o th er au th o rs
in relatio n to p atien ts w ith v arico cele an d also in an im aIs
B A P T IS T A -S IL V A ,J.C .C .; D O L N IK O F F ,M .S .; M O U R A , L .A .R . e t a I. - L ig a tio n o f th e le ft re n a l ve in in e p m 1 -w ista r ra ts: fu n ctio n a l a n d m o rp h o lo g ic a lte ra tio n s in th e kid n e ys,
te ste s a n d su p ra re n a l g la n d s
1480
with stenosis of LRV. These authors have also found an
increase
of luteinizing
hormones,
follicle-stimulating,
prolactin,
oligosperrnia and zoosperrnia.I04,107,108,117,131
The
histological anal ysis of our study showed a severe bilateral
testicular lesion in three of the four groups of ligation, more
pronounced
to the left on the 30th and 60th day. Other
researchers
found bilateral
testicular
lesions and they
considered that these could be induced by immunocomplex
reaction.86,132-137
Other studies must be conducted to further
investigate testicular injuries caused by varicocele,138 but it
has been ..suggested that a defect in the testicular energetic
metabolism caused by varicocele may be associated to the
worsening of spermatogenesis in rats.139
In the suprarenal
glands
we found
bilateral
histologicallesions
in most periods, but with no statistical
difference,
although we could find nothing in medicaI
literature concerning
suprarenal
gland lesion provoked
by varicocele
or by LLRV. Other
authors
reported
suprarenal
gland lesions
such
as hemorrhage
and
necrosis, caused by stress, operation or post thrombosis
of the inferior vena cava or of LRV in
the newborn.
64,77,78,84
We can report that the ligation
of the left renal
vein close to the inferior vena cava in male adult EPM
1-WISTAR
rats leads to a severe bilateral
histological
lesion in the kidneys, testes
especially
on the left side.
The results
of the biochemical
analysis
were not
sufficient
to demonstrate
functional
alterations.
Histopathological
analysis was considered
the best test
for assessment
of lesions caused
by LLRV.
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