Renal Compression in Heart Failure: The Renal Tamponade Hypothesis

State-of-the-Art Review

Eva M. Boorsma, MD; Jozine M. ter Maaten, MD, PHD; Adriaan A. Voors, MD, PHD; Dirk J. van Veldhuisen, MD, PHD


JACC Heart Fail. 2022;10(3):175-183. 

In This Article

Renal Decapsulation

Loss of renal function through compression of the kidney by the renal capsule suggests that renal decapsulation may improve renal function in patients with congestive HF. This was confirmed in a rat model of renal congestion, where decapsulation reduced tubular damage.[20]

Data on decapsulation in humans is more than 100 years old.[41] In the late 19th and early 20th centuries, renal capsular incision or full decapsulation was a treatment often performed for various indications, ranging from renal abscesses to pre-eclampsia and oliguria, but not congestive HF.[41] Better alternatives such as dialysis and antibiotic treatment, as well as contradicting results on the benefit of decapsulation on renal outcomes, eventually rendered renal decapsulation obsolete in acute kidney injury.[42,43] However, recently decapsulation has been shown to alleviate ischemic acute kidney injury in piglets, potentially reviving the technique.[44] To date, no data on renal decapsulation in humans with HF exist.