The Effect of Ischemic Preconditioning in the Experimental Model of Renal Ischemia Reperfusion Injury Using Single Nephrectomized Porcine.

Abstract

Purpose: We evaluate organ protective function of remote ischemic preconditioning (IPC) in renal ischemia reperfusion injury using a single-kidney porcine model. Methods: A total of 15 Yorkshire pigs, weighting 35-38kg and 20 week-old, were used. One week (as an adaption period) later from left nephrectomy, we performed IPC and right renal artery clamping (warm ischemia). We divided the animals into 3 experimental groups of 5 animals each; control group: 90 min warm ischemia without IPC, group 1: 2 cycles of 10 min IPC followed by 90 min warm ischemia, group 2: 2 cycles of 10 min IPC, and 24 hours as a window period followed by 90 min warm ischemia. Urinary NGAL, KIM-1, IL-18, cystatin C and microalbumin were measured as renal injury makers before renal ischemia at POD 1 and 3. Also gene microarray was investigated using kidney tissue after euthanasia. Results: There were no differences in serum creatinine changes between groups (figure 1). However, Group 3 showed lower level of KIM-1 and NGAL than control and group 1 at 72 hours. Microalbumin also showed a tendency of lower level in group 2. In the microarray, group 1 had 198 gene expression differences compared to the control group (figure 2). However group 2 had 1027 gene expression differences. Ischemic precondition groups (group 1 & 2) had 179 altered gene expressions in common that are mostly related with apoptosis, inflammation, and oxidation. When we compare group 1 and 2, group 2 had more increases in inflammation regulatory gene expressions (C3, C1QA, and SAA2).Figure: No Caption available.Table: No Caption available.Conclusion: Remote IPC can mitigate renal damage from ischemia reperfusion injury. Late window IPC is especially more efficient than early window.