Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology
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To perform a review on the latest evidence related to normal and pathological intrarenal pressures (IRPs), complications of incremented values, and IRP ranges during endourology.
A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model, and human studies. Different keywords were: percutaneous nephrolithotomy, PCNL, ureteroscopy, URS, RIRS, irrigation flow, irrigation pressure, intrarenal pressure, intrapelvic pressure and renal pelvic pressure.
Normal IRPs range from zero to a few cm H2O. Pyelovenous backflow may occur at pressure range of 13.6–27.2 cm H2O. During upper tract endourology, complications such as pyelorenal backflow, sepsis, and renal damage are directly related to increased IRPs. Duration of increased IRPs and concomitant obstruction are independent predictors of complication development.
IRP increase remains a neglected predictor of upper tract endourology complications and its intraoperative monitoring should be taken into consideration. Further research is necessary, to quantify pressures generated during upper tract endourology, and introduce means of controlling them.
KeywordsPercutaneous nephrolithotomy PCNL Ureteroscopy URS RIRS Irrigation flow Irrigation pressure Intrarenal pressure Intrapelvic pressure Renal pelvic pressure
TT: Data management, data analysis, manuscript writing. TRW Herrmann: Interpreting data. AS: Interpreting data. UN: Protocol/project development and interpreting data.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human and animal rights
This review does not involve human participants and/or animals.
- 15.Pfister RC, Newhouse JH, Hendren WH (1982) Percutaneous pyeloureteral urodynamics. Urol Clin North Am 9(1):41–49Google Scholar
- 18.Stenberg A, Bohman SO, Morsing P, Muller-Suur C, Olsen L, Persson AE (1988) Back-leak of pelvic urine to the bloodstream. Acta Physiol Scand 134(2):223–234. https://doi.org/10.1111/j.1748-1716.1988.tb08483.x CrossRefGoogle Scholar
- 25.Hahn RG (1991) Monitoring of TURP with ethanol. Lancet (London, England) 338(8782–8783):1602Google Scholar
- 28.Xu S, Shi H, Zhu J, Wang Y, Cao Y, Li K, Wang Y, Sun Z, Xia S (2014) A prospective comparative study of hemodynamic, electrolyte, and metabolic changes during percutaneous nephrolithotomy and minimally invasive percutaneous nephrolithotomy. World J Urol 32(5):1275–1280. https://doi.org/10.1007/s00345-013-1204-2 CrossRefGoogle Scholar
- 30.Sinclair JF, Hutchison A, Baraza R, Telfer AB (1985) Absorption of 1.5% glycine after percutaneous ultrasonic lithotripsy for renal stone disease. Br Med J (Clinical research ed) 291(6497):691–692Google Scholar
- 38.Omar M, Noble M, Sivalingam S, El Mahdy A, Gamal A, Farag M, Monga M (2016) Systemic inflammatory response syndrome after percutaneous nephrolithotomy: a randomized single-blind clinical trial evaluating the impact of irrigation pressure. J Urol 196(1):109–114. https://doi.org/10.1016/j.juro.2016.01.104 CrossRefGoogle Scholar
- 42.Li X, Liu M, Bedja D, Thoburn C, Gabrielson K, Racusen L, Rabb H (2012) Acute renal venous obstruction is more detrimental to the kidney than arterial occlusion: implication for murine models of acute kidney injury. Am J Physiol Renal Physiol 302(5):F519–F525. https://doi.org/10.1152/ajprenal.00011.2011 CrossRefGoogle Scholar
- 50.Thomsen HS (1984) Pyelorenal backflow. Clinical and experimental investigations. Radiologic, nuclear, medical and pathoanatomic studies. Dan Med Bull 31(6):438–457Google Scholar
- 57.Cao Z, Yu W, Li W, Cheng F, Xia Y, Rao T, Yao X, Zhang X, Larre S (2013) Acute kidney injuries induced by various irrigation pressures in rat models of mild and severe hydronephrosis. Urology 82 (6):1453.e1459–1416. https://doi.org/10.1016/j.urology.2013.08.024
- 58.Landman J, Venkatesh R, Ragab M, Rehman J, Lee DI, Morrissey KG, Monga M, Sundaram CP (2002) Comparison of intrarenal pressure and irrigant flow during percutaneous nephroscopy with an indwelling ureteral catheter, ureteral occlusion balloon, and ureteral access sheath. Urology 60(4):584–587CrossRefGoogle Scholar