Morphological Alterations in the Kidney Following Different Durations of Warm Ischemia: An Experimental Study

ORIGINAL ARTICLE
Ulugbek Abduganiev, Muhammadaziz Aliev, Pulat Sultanov

 
For citation: Abduganiev U, Aliev M, Pulat Sultanov P. Morphological Alterations in the Kidney Following Different Durations of Warm Ischemia: An Experimental Study. International Journal of Biomedicine. 2025;15(2):346-350. doi:10.21103/Article15(2)_OA12
 
Originally published June 5, 2025
 

Abstract: 

Background: Kidney transplantation is recognized as the most effective treatment for patients with end-stage kidney disease. However, the increasing use of donation after circulatory death has led to more extended periods of warm ischemia, which can threaten graft function.
The aim of this study was to evaluate morphological alterations in the kidneys following different durations of renal warm ischemia (RWI) in the experiment.
Methods and Results: The experiments were carried out on 78 white male rats weighing 214.5±31.8 g. The intraoperative RWI was modeled by clamping the renal arteries on both sides through a median laparotomy under ether anesthesia. Vascular clamping lasted 12, 24, 36, or 48 minutes in four experimental groups of rats, each containing 18 rats. Clamping of the arteries was carried out by temporarily ligating with a special loop (like an end-loop) of the renal hilum. Surgical procedures were performed on a heated pad to avoid cold-induced hemodynamic alterations. After the laparotomy, the wound was sutured tightly. Each group was further subdivided into three subgroups (6 rats in each subgroup) to be euthanized by decapitation on Days 3, 7, and 14 of the experiment. Kidneys were removed for morphological study. The intact group of rats became the control group (n=6). Macroscopic changes, such as discoloration and swelling, were documented, and tissues were examined histologically with hematoxylin and eosin staining.

Our results showed that 12- and 24-minute Warm ischemia time (WIT) caused relatively mild circulatory disturbances and tubular changes, most of which were resolved by Day 14. The WIT up to 36 minutes led to a more pronounced injury, including noticeable edema, dystrophic changes, and occasional necrosis. Still, a fair amount of tissue recovery was evident by Day 14, although some cells showed persistent apoptotic alterations. In contrast, the WIT up to 48 minutes led to severe, largely irreversible damage characterized by extensive necrosis and structural disintegration.
Conclusion: The findings emphasize the value of minimizing WIT, suggesting that 24 minutes or less allows for significant renal recovery, whereas prolonged WIT can cause long-lasting or permanent tissue injury.

Keywords: 
warm ischemia • kidney transplantation • ischemia-reperfusion injury • acute tubular necrosis
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Received February 14, 2025.
Accepted April 23, 2025.
©2025 International Medical Research and Development Corporation.