Postconditioning in major vascular surgery: prevention of renal failure

Journal of Translational Medicine

Attila Szijarto¹  Laszlo Harsanyi¹  Zsolt Balla²  Zoltan Rakonczay²  Viktor Hegedus¹  Janos Geleji³  Gabor Lotz⁴  David Garbaisz¹  Zsolt Turoczi¹  Peter Aranyi¹ 

[1] 1st Department of Surgery, Semmelweis University, Budapest, Hungary;First Department of Internal Medicine, University of Szeged, Szeged, Hungary;Eötvös Loránd University, Faculty of Science, Institute of Mathematics, Budapest, Hungary;2nd Department of Pathology, Semmelweis University, Budapest, Hungary

关键词: HSP72;    Renal microcirculation;    Postconditioning;    Myoglobinuria;   

Others  :  1139259
DOI  :  10.1186/s12967-014-0379-7

 received in 2014-06-25, accepted in 2014-12-30,  发布年份 2015

【 摘 要 】

Background

Postconditioning is a novel reperfusion technique to reduce ischemia-reperfusion injuries. The aim of the study was to investigate this method in an animal model of lower limb revascularization for purpose of preventing postoperative renal failure.

Methods

Bilateral lower limb ischemia was induced in male Wistar rats for 3 hours by infrarenal aorta clamping under narcosis. Revascularization was allowed by declamping the aorta. Postconditioning (additional 10 sec reocclusion, 10 sec reperfusion in 6 cycles) was induced at the onset of revascularization. Myocyte injury and renal function changes were assessed 4, 24 and 72 hours postoperatively. Hemodynamic monitoring was performed by invasive arterial blood pressure registering and a kidney surface laser Doppler flowmeter.

Results

Muscle viability studies showed no significant improvement with the use of postconditioning in terms of ischemic rhabdomyolysis (4 h: ischemia-reperfusion (IR) group: 42.93 ± 19.20% vs. postconditioned (PostC) group: 43.27 ± 27.13%). At the same time, renal functional laboratory tests and kidney myoglobin immunohistochemistry demonstrated significantly less expressed kidney injury in postconditioned animals (renal failure index: 4 h: IR: 2.37 ± 1.43 mM vs. PostC: 0.92 ± 0.32 mM; 24 h: IR: 1.53 ± 0.45 mM vs. PostC: 0.77 ± 0.34 mM; 72 h: IR: 1.51 ± 0.36 mM vs. PostC: 0.43 ± 0.28 mM), while systemic hemodynamics and kidney microcirculation significantly improved (calculated reperfusion area: IR: 82.31 ± 12.23% vs. PostC: 99.01 ± 2.76%), and arterial blood gas analysis showed a lesser extent systemic acidic load after revascularization (a defined relative base excess parameter: 1^st s: IR: 2.25 ± 1.14 vs. PostC: 1.80 ± 0.66; 2^nd s: IR: 2.14 ± 1.44 vs. PostC: 2.44 ± 1.14, 3^rd s: IR: 3.99 ± 3.09 vs. PostC: 2.07 ± 0.82; 4^th s: IR: 3.28 ± 0.32 vs. PostC: 2.05 ± 0.56).

Conclusions

The results suggest a protective role for postconditioning in major vascular surgeries against renal complications through a possible alternative release of nephrotoxic agents and exerting a positive effect on hemodynamic stability.

【 授权许可】

   
2015 Aranyi et al.; licensee BioMed Central.

【 图 表 】

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