Abstract
To compare fluid replacement therapy with Hydroxyethyl starch 6% (HES) versus Ringer's lactate (RL) in a rodent model of non-septic renal ischemia. Forty male Wistar rats were randomized to receive HES 2 ml.kg(-1).hr(-1) or RL 5 ml.kg(-1).hr(-1) that underwent 30 minutes of renal ischemia followed by reperfusion. Twelve hours after kidney ischemia, the kidneys were evaluated for histological changes. Serum NGAL levels were obtained at different times of the experimental protocol. Rodents in the HES group had a median (IQR) grade of renal injury 3 (3 to 5) compared to 2 (2 to 4) in the RL group (p=0.03). NGAL levels were not associated with the severity of kidney injury. Hydroxyethyl starch administration caused more kidney injury than Ringer's lactate in a non-infectious model of renal hypoperfusion.
Highlights
Acute renal failure affects up to 5% of hospitalized patients and its prevalence is expected to increase in the coming years[1].Besides causing an increase in mortality, the development of acute renal failure in hospitalized patients can lead to a greater length of hospitalization and increase in health care costs[2].Ischemic kidney damage is one of the most important pathophysiologic mechanisms of acute renal failure[3]
After establishment of the central venous access, the fluid replacement solution was started in both groups using an infusion pump( ANNE, Abbott Laboratories, Abbott Park, USA) using 5ml.kg -1 hr-1 Ringer’ lactate (HalexIstar, Sao Paulo, Brazil ) for Group 1 and 2 ml.kg-1.hr -1of 6% Hydroxyethyl starch (Voluven, Hospira, Lake Forest, USA) for Group 2
Statistical analysis A power analysis determined that 18 rodents per group would be required in order to achieve 80% power to detect an alternative hypothesis of a one grade of kidney lesion difference in the Hydroxyethyl starch group compared to the Ringer’s lactate group, using one lesion grade as a standard deviation and a two sided non parametric Mann-Whitey U test
Summary
Acute renal failure affects up to 5% of hospitalized patients and its prevalence is expected to increase in the coming years[1].Besides causing an increase in mortality, the development of acute renal failure in hospitalized patients can lead to a greater length of hospitalization and increase in health care costs[2].Ischemic kidney damage is one of the most important pathophysiologic mechanisms of acute renal failure[3]. Fluid replacement therapy is the cornerstone to prevent and treat acute kidney failure in hypoperfusion states[4]. Colloid infusions have been shown to be detrimental to kidney function when compared to crystalloid infusions in a rodent model of sepsis[7]. It is unknown if colloid administration is detrimental to the kidneys in non- infectious states of renal hypoperfusion. The primary objective of the current investigation was to evaluate the effect of 6% Hydroxyethyl starch versus Ringer’s lactate replacement therapy on the degree of acute kidney injury in a non- infectious rodent model of renal ischemia. We hypothesized that rodents receiving a crystalloid infusion would have less acute structural kidney damage than rodents receiving a colloid infusion
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