Crosstalk between inflammation and coagulation in acute kindey injury in experimental and clinic acute pancreatitis

Abstract

Background: Acute pancreatitis (AP) is an inflammatory syndrome with unpredictable progression to systemic inflammation and MODS. Acute renal failure (ARF) is an early severe complication of AP. Materials and methods: AP was induced in 42 Wistar albino rats by intraperitoneal injection with 3 g/kg L-ornithine-HCl in 26 rats. 16 rats - control group. In experiment we determined the levels of amylase, creatinine, H2S, fibrinogen and time of recalcification in serum, activity of NO-synthase and myeloperoxidase in pancreas, the pathological changes of pancreas and kidneys were shown by hematoxylin and eosin staining. We examined 98 patients with moderate AP and 57 patients with severe AP. Disorders of kidney function were in 48 patients. We determined the creatinine level, indicators of hemostasis and inflammation. Results: In rats ARF was proved by histology. The concentration of creatinine in serum increased at 86.86%. The level of creatinine directly correlated with myeloperoxidase and activity of iNOS in the pancreas, amylase in serum, reverse with H2S in serum. ARF was accompanied by hypercoagulation. Relationship of inflammation and hemostasis in patients with AP and ARF is accompanied by decreased of aPTT, increased of TT, fibrinogen, D-dimers and level of SFMC, lack of activity of antithrombin III, increased of CRP, IL-2, IL-6, and TNF-α. There was also direct correlation between severity of renal failure and concentrations of IL-6 CRP, D-dimers, SFMC and TT. Conclusion: The inflammatory cascades and hypercoagulative state initiate ARF following ANP. Understanding of this process is important for the treatment of patients with severe AP.