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| Renal protective effect and its related mechanisms of elevated abdominal perfusion pressure treatment in acute kidney injury model caused by intra-abdominal hypertension |
| Zheng Yue, Ma Wen-liang, Jiang Yi-jia, Huang Li-feng, Sui Feng, Li Wen Xiong |
| SICU, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China |
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Abstract Objective To evaluate the renal protective effect of targeted abdominal perfusion pressure (APP) treatment in intra-abdominal hypertension (IAH) and further investigate its related mechanisms. Methods Twelve healthy pigs were randomly divided into experimental and control group, each had 6 pigs. All animals were collected urine output per hour, continuously monitored mean arterial pressure (MAP) and renal cortical perfusion using laser Dopple perfusion imaging(LDPI) after anesthesia. IAH models were established by intraperitoneally injecting carbon dioxide in all animals, the baseline MAP, intra-abdominal pressure (IAP) and APP were obtained before IAH models established. In both groups, IAP was raised gradually from baseline to 10 mm Hg, 15 mm Hg, 20 mm Hg and 25 mm Hg. In control group, IAP was maintained at 25 mm Hg for 8 hours without any other interventions. In experimental group, the animals were intravenously given with norepinephrine in order to get a target level of APP equal to its baseline values after 15 minutes of the onset of 25 mm Hg IAP. Changes of renal cortical perfusion, serum creatinine, TNF-α, IL-6 and urine IL-18 with the alteration of IAP in both groups were explored. Animals were then sacrificed for renal histopathology after 8 hours of the onset of 25 mm Hg IAP. Results With the increase of IAP, renal cortical perfusion in both groups was significantly decreased (P<0.05). Compared to its baseline, SCr and urinary IL-18 were significantly increased after the maintenance of IAP at 25 mm Hg for 8 hours in control group (P<0.05). And, the level of serum TNF-α and IL-6 also increased significantly (P<0.05). In experimental group, which utilized a strategy of elevated APP, significant improvement of the renal cortical perfusion was observed (P<0.05). SCr and urinary IL-18 were significantly decreased(P<0.05), but TNF-α, IL-6 did not changed significantly(P>0.05). Renal histopathological examination illustrated edema of glomerulus and tubules in specimens of both groups. Conclusion Maintaining IAP of 25 mm Hg for 8 hours can successfully make the model of AKI. The elevated APP treatment may have a renal protective function within the first 8 hours of IAH by improving renal cortical perfusion rather than affecting systemic inflammatory response.
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Received: 09 September 2017
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Corresponding Authors:
Sui Feng, E-mail：sicusuifeng@163.com
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