Research has demonstrated that hypertension can lead to an exaggeration in the renal functional and histological changes caused by ureteral obstruction. These changes were particularly observed shortly after the release of a relatively brief period of unilateral ureteral obstruction (UUO). However, the long-term impact of hypertension on the recovery of renal functions has not been investigated beyond the immediate period after UUO reversal. In order to investigate this effect, a group of spontaneously hypertensive rats (G-SHR, n = 11) and a group of normotensive Wistar Kyoto rats (G-NTR, n = 11) were subjected to a 48 h reversible left UUO. The impact of UUO was then examined 45 days after the reversal of obstruction. The glomerular filtration rate, renal blood flow, and the fractional excretion of sodium in the post-obstructed left kidney (POK) showed similarities to the non-obstructed right kidney (NOK) in both groups. However, the changes in the albumin creatinine ratio, renal injury markers, pro-apoptotic markers, and histological changes in the G-SHR were much more pronounced compared to the G-NTR. We conclude that hypertension continues to have a significant impact on various aspects of renal injury and function, even several weeks after UUO reversal.

Both ureteral obstruction (UO) and hypertension are common conditions that affect kidney functions. Hypertension and chronic kidney disease are closely associated with an overlapping and intermingled cause-and-effect relationship. The effect of hypertension on the renal dysfunction following reversible UO has not been studied previously. To study this effect, spontaneously hypertensive (G-HT, n = 10) and normotensive Wistar (G-NT, n = 10) rats underwent 48-h reversible left unilateral UO (UUO), and the effect of UUO was studied 96 h following UUO reversal. The glomerular filtration rate, renal blood flow, and renal tubular functions such as the fractional excretion of sodium in the post-obstructed left kidney (POK) in both groups were significantly altered compared with the non-obstructed right kidney (NOK). However, the alterations in the G-HT were significantly more exaggerated when compared with the G-NT. Similar findings were observed with the histological features, gene expression of kidney injury markers, pro-inflammatory, pro-fibrotic and pro-apoptotic cytokines, and pro-collagen, as well as tissue levels of apoptotic markers. We conclude that hypertension has significantly exaggerated the alterations in renal functions and other parameters of renal injury associated with UUO.

Renal ischemia-reperfusion injury (IRI) is an inevitable consequence of several clinical conditions and surgical procedures including renal transplantation and resuscitation following systemic hypotension. It leads to immediate renal dysfunction and might result in long-term renal damage. Therefore, there is an ongoing effort to mitigate the deleterious effects of the IRI on the kidney. Recently, there has been a recent interest in using natural compounds as alternative remedies in many diseases. Thus, the aim of this research was to study the effect of nuciferine, a phytochemical compound extracted from the plant Nelumbo nucifera Gaertn, on the renal dysfunction in a rat mode of IRI. Nuciferine was administered orally as single daily dose of 30 mg/kg for 9 days prior to IRI and continued for 3 days post-IRI. G-Sham (n = 11) underwent sham surgery whereas G-IRI (n = 12) and G-IRI/NF (n = 12) underwent bilateral warm renal ischemia for 35 minutes. G-IRI/NF received nuciferine. Renal functions and histological changes were assessed before starting the medication, just prior to IRI and 3 days after IRI. Nuciferine significantly attenuated the alterations in serum creatinine, serum urea, creatinine clearance and urinary albumin creatinine ratio. This was associated with significant attenuation of the alterations in renal injury markers, several cytokines including pro-inflammatory, pro-fibrotic and apoptotic cytokines and in histological changes. In conclusion, nuciferine has reno-protective effects on the IRI-induced renal dysfunction. These findings might be of clinical significance.

Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a very important circulatory support system, and its use is increasing over the years especially in pregnancy and its related consequences on the mother and the fetus. This article is directed to review all the important aspects regarding VA-ECMO in pregnancy, addressing that it is less commonly used during pregnancy not disregarding maternal, neonatal, and long-term outcomes such as, the survival rate is relatively good compared to the general population adjusted to different causes mentioned in this article. A description of what VA-ECMO is, protocols, usual targeted goals, preferred sites of access especially peripheral cannulation, indications including multiple causes of cardiac failure, some contraindications majorly end-stage cardiac failure when recovery or transplant is not possible, the use of anticoagulation and its side effects, specific complications including bleeding from multiple sites, and the incidence of thromboembolic complications. Moreover, a good clarification and thorough discussion is intended for some of the special considerations and technical challenges in pregnancy due to uterine compression, maternal susceptibility for thrombosis and infections, the status of the fetus and the mode of delivery.

Extracorporeal membrane oxygenation (ECMO) is a specialized technique providing temporary support for failed cardiac and respiratory functions. While commonly used in neonates and children, its application in obstetric patients is gaining traction. In hypoxemic and hypercapnic respiratory failure with intact cardiac function, Veno-Venous ECMO (VV-ECMO) offers artificial oxygenation and decarboxylation. This comprehensive article discusses VV-ECMO in obstetrics, covering prevalence, maternal and neonatal outcomes, mechanisms, protocols, access sites, indications, contraindications, anticoagulation, complications, and considerations. The VV-ECMO procedure involves redirecting blood from the heart or major veins through an artificial lung and back to the heart, improving oxygenation, respiratory mechanics, and cardiac function while reducing lung injury risk. Cannulation methods range from double-lumen to bi-femoral, depending on patient needs. Prevalence of VV-ECMO in pregnancy is 8.9%. Outcomes vary based on factors like medical condition and gestational age. Survival rates range from 63% to 76% for pregnant patients and 70% to 86% for infants. Common indications encompass severe H1N1 influenza, pre-eclampsia, and viral infections. Contraindications involve refusal, end-stage malignancy, and severe neurologic injury. Anticoagulation, crucial for preventing clotting in the ECMO circuit, primarily employs unfractionated heparin. Complications include bleeding, thrombosis, and infections. In pregnancy, similar indications exist, with VV-ECMO typically proving safe and effective for both maternal and fetal survival.