Abstract
BackgroundThe effects of blood transfusion on renal microcirculation during sepsis are unknown. This study aimed to investigate the effect of blood transfusion on renal microvascular oxygenation and renal function during sepsis-induced acute kidney injury.MethodsTwenty-seven Wistar albino rats were randomized into four groups: a sham group (n = 6), a lipopolysaccharide (LPS) group (n = 7), a LPS group that received fluid resuscitation (n = 7), and a LPS group that received blood transfusion (n = 7). The mean arterial blood pressure, renal blood flow, and renal microvascular oxygenation within the kidney cortex were recorded. Acute kidney injury was assessed using the serum creatinine levels, metabolic cost, and histopathological lesions. Nitrosative stress (expression of endothelial (eNOS) and inducible nitric oxide synthase (iNOS)) within the kidney was assessed by immunohistochemistry. Hemoglobin levels, pH, serum lactate levels, and liver enzymes were measured.ResultsFluid resuscitation and blood transfusion both significantly improved the mean arterial pressure and renal blood flow after LPS infusion. Renal microvascular oxygenation, serum creatinine levels, and tubular damage significantly improved in the LPS group that received blood transfusion compared to the group that received fluids. Moreover, the renal expression of eNOS was markedly suppressed under endotoxin challenge. Blood transfusion, but not fluid resuscitation, was able to restore the renal expression of eNOS. However, there were no significant differences in lactic acidosis or liver function between the two groups.ConclusionsBlood transfusion significantly improved renal function in endotoxemic rats. The specific beneficial effect of blood transfusion on the kidney could have been mediated in part by the improvements in renal microvascular oxygenation and sepsis-induced endothelial dysfunction via the restoration of eNOS expression within the kidney.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1581-1) contains supplementary material, which is available to authorized users.
Highlights
The effects of blood transfusion on renal microcirculation during sepsis are unknown
The rats were randomized into four groups: (1) a sham operation group, (2) a lipopolysaccharide (LPS) group (n = 7), (3) a LPS group with fluid resuscitation and a targeted mean arterial pressure (MAP) of 80– 90 mmHg (LPS + FR, n = 7), and (4) a LPS group with blood transfusion and a targeted MAP of 80–90 mmHg (LPS + BT, n = 7)
At the end of the experiment, there were no significant differences in terms of the systemic or renal hemodynamic parameters between the groups that received FR or BT after LPS infusion
Summary
The effects of blood transfusion on renal microcirculation during sepsis are unknown. This study aimed to investigate the effect of blood transfusion on renal microvascular oxygenation and renal function during sepsis-induced acute kidney injury. Renal microvascular oxygenation is highly sensitive to endotoxemia, and renal hypoxia plays a Zafrani et al Critical Care (2016) 20:406 transfusion of oxygen-carrying red blood cells would improve sepsis-induced hypoxia. Two clinical studies have examined the ability of blood transfusion (BT) to correct the perfusion and oxygenation of the microcirculation in septic shock patients [7, 8]. These studies demonstrated that the microcirculation is globally unaltered by BT in septic patients; patients with altered capillary perfusion at baseline improve after BT [7]. No study has focused on the effect of BT on sepsis-induced AKI
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