Kidney Decapsulation

KIDNEY DECAPSULATION (decapsulatio renis), removal of the kidney capsule, so-called fibrous capsule, caps. propria renis. For therapeutic purposes, D. began to be used by Harrison and Edebohls from 1901 in the treatment of kidney diseases associated with renal insufficiency due to improper blood supply. Edebohls considered the fibrous capsule of the kidney a barrier between intra- and extrarenal circulation, consequently, in his opinion, it was sufficient to remove this capsule to improve circulation in the kidney; this opinion was supported by a number of authors (Lorenz, Kummell, Tuffier, Albarran and others). A series of experimental works sometimes demonstrated a significant positive effect of D. p. (Claude et Balthazard, Albarran et L. Bernard, Stursberg, Anzilotti, Bonch-Osmolovsky, Sessagé and others) and, conversely, sometimes revealed deterioration, since soon after decapsulation the capsule was restored again, thicker and denser than before (Walker Hall, Herxheimer, Zondek, Lanz, Liek and others). To create collateral circulation, Parlaviccio (Parlavecchio), Girgolav and others propose to wrap the decapsulated kidney with omentum or, by simultaneously incising the kidney parenchyma, to introduce its omentum into the wound. In humans, the application of this operation was unsuccessful, and so far it has a laboratory character: However, the experiment, which sought to clarify the effect of D. on the kidney and its functions, by no means accurately reproduced the condition of the kidneys in which D. is recommended, for which reason the result was insignificant, sometimes zero, not corresponding to clinical observation, where D. often gives a striking effect, especially in the direction of increasing diuresis and subsequent improvement of renal function, if, of course, the renal epithelium and glomeruli have not been destroyed by the process and there is no sclerosis of the vessels. To explain the significance of D., there are a number of different theories: 1) freeing the kidney from strangulation by its capsule - Harrison and Edebohls' mechanical theory; 2) formation of collaterals to restore circulation - Apostolozzi's theory; 3) periarterial sympathectomy of the renal artery with subsequent improvement of blood supply to the kidney due to dilation of the arteries - theory of partial denervation by Jaboulay, Kummell; 4) nonspecific protein therapy, which can also occur with a simple incision of the skin in the lumbar region or X-ray irradiation - as yet unproven theory of Volhard; 5) drainage, removal of blood and lymph,

Figure 1. Incision of the kidney capsule using a probe. (From Bier-Braun-Kummell.)

Figure 2. Blunt dissection of the kidney from the capsule. (From Bier-Braun-Kummell.)

the so-called "bloody and watery sweat", appearing on the surface of the parenchyma during decapsulations in cases of staphylo-strepto-coli-bacillary hematogenous nephritis. - Technique of decapsulation. After incision of the muscles and fascias, the kidney is freed from its fatty bed. A window is made in its capsule, through which a probe is passed under the capsule, and the capsule is incised with a scalpel along the probe (see Figure 1). The edges of the capsule in the incision are grasped with clamps, and with careful movement of the finger or probe, the capsule is separated from the renal parenchyma first on one surface, then on the other (see Fig. 2). The separated capsule can be left in place or resected with scissors (see Figure 3). In cases where the so-called capsular method is used to fix a mobile kidney, a flap decapsulation of the kidney is performed, and the kidney is sutured to these flaps. The bleeding from the renal parenchyma observed during D. quickly stops as soon as the kidney is placed in its fatty bed. The wound is sutured tightly; some urologists recommend inserting a drain into the lower angle of the wound for 48 hours. - Indications for kidney decapsulation can be considered: 1) acute nephritis or nephro-nephritis with oliguria or anuria; 2) essential renal hemorrhage; 3) acute or chronic nephritis with severe hematuria; 4) mercurial nephrosis and cantharidin nephro-nephritis; 5) apostematous nephritis, unilateral multiple abscesses of the kidneys (with them, the removal of toxic products, drainage, diversion of blood and lymph is achieved); 6) eclampsia with azotemia (with increased intrarenal pressure).

Figure 3. Excision of the freed capsule at the hilus of the kidney. (From Bier-Braun-Kummell.) urinary organs, L., 1906; Israel J. u. Israel W., Chirurgie der Niere und des Harnleiters, Lpz., 1925; Vogel K., Die Decapsulation der Niere, Munch. med. Wochenschr., 1921, № 5; Zondek M., Die Decapsulation u. die Scarification der Niere u. ihre klinische Bedeutung, Berliner klinische Wochenschrift, 1911, № 13.