Efectos de la injuria renal isquémica aguda en la disfunción extrarenal. Estudio experimental aleatorizado
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2013
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es
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Sociedad Chilena de Pediatría
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Licencia CC
Resumen
Introducción: La insuficiencia renal aguda (IRA) es una enfermedad grave y causante de disfunciones de órganos distantes que incrementan su mortalidad. Objetivo: Identificar disfunción hemodinámica y respiratoria gatillada por IRA en un modelo pediátrico animal de isquemia-reperfusión renal. Método: Doce cerdos anestesiados (11,9 ± 1,0 kg). En seis animales se indujo lesión renal bilateral por isquemia-reperfusión: 45 min de isquemia y 240 min de reperfusión, mientras que los seis animales restantes fueron grupo control. En condiciones basales y posterior a lesión renal se realizó monitorización hemodinámica convencional y termodilución transpulmonar. Paralelamente se midió gasometría arterial y análisis de mecánica pulmonar. Resultados: Hubo un incremento de la precarga volumétrica en 29% (221 ± 22 ml/m2 vs 286 ± 16 ml/m2, p = 0,04) y de la presión arterial media en 58% (71 ± 6 mmHg vs 112 ± 17 mmHg, p = 0,04) respecto a controles, sin cambios en frecuencia cardíaca, presión venosa central ni gasto cardíaco. Además ocurrió un aumento del agua extravascular pulmonar en 86% (7,6 ± 0,6 ml/kg vs 14,1 ± 1,4 ml/kg, p = 0,02), sin cambios en intercambio gaseoso ni mecánica pulmonar. Simultáneamente hubo un leve deterioro de la creatinina sérica (1,12 ± 0,07 mg/dL vs 1,45 ± 0,10 mg/dL, p = 0,03). Discusión: En este modelo experimental se pudo apreciar el desarrollo temprano de disfunción hemodinámica y pulmonar. Se evidenció un aumento de la precarga volumétrica y de la presión arterial, asociado a un incremento substancial del agua extravascular pulmonar. Creemos que es fundamental monitorizar de forma seriada la función hemodinámica y respiratoria en sujetos con una lesión renal aguda, aún sin una IRA urémica.
Acute kidney injury (AKI) is a serious disease that can cause distant organ injuries and is associated with high mortality rates. Objective: To identify the hemodynamic and respiratory dysfunction triggered by AKI, in an animal model of renal ischemia-reperfusion. Method: Twelve anesthetized juvenile pigs (11.9 ± 1.0 kg). Six animals underwent ischemia/reperfusion-induced AKI: 45 min of ischemia and 240 minutes of reperfusion, while the remaining six animals were the control group. In basal conditions and after AKI, a conventional hemodynamic monitoring and transpulmonary thermodilution were performed. At the same time, arterial blood gases and lung mechanics were measured. Results: There was a 29% increase in volumetric preload (221 ± 22 ml/m2 vs 286 ± 16 ml/m2, p = 0.04) and a 58% mean arterial pressure increase (71 ± 6 mmHg vs 112 ± 17 mmHg, p = 0.04) compared to controls, without changes in heart rate, central venous pressure and cardiac output. In addition, an increase of 86% in extravascular lung water (7.6 ± 0.6 ml/kg vs 14.1 ± 1.4 ml/ kg, p = 0.02) was reported, without changes in gas exchange and lung mechanics. Simultaneously, a slight increase in serum creatinine (1.12 ± 0.07 mg/dl vs 1.45 ± 0.10 mg/dl, p = 0.03) was described. Discussion: An early development of hemodynamic and pulmonary dysfunction was observed in this experimental reperfusion model. An increase in volumetric preload and blood pressure associated with a substantial increase in the extravascular lung water were also reported. It is essential serially monitor the hemodynamic and respiratory functions in AKI, including nonuremic subjects.
Acute kidney injury (AKI) is a serious disease that can cause distant organ injuries and is associated with high mortality rates. Objective: To identify the hemodynamic and respiratory dysfunction triggered by AKI, in an animal model of renal ischemia-reperfusion. Method: Twelve anesthetized juvenile pigs (11.9 ± 1.0 kg). Six animals underwent ischemia/reperfusion-induced AKI: 45 min of ischemia and 240 minutes of reperfusion, while the remaining six animals were the control group. In basal conditions and after AKI, a conventional hemodynamic monitoring and transpulmonary thermodilution were performed. At the same time, arterial blood gases and lung mechanics were measured. Results: There was a 29% increase in volumetric preload (221 ± 22 ml/m2 vs 286 ± 16 ml/m2, p = 0.04) and a 58% mean arterial pressure increase (71 ± 6 mmHg vs 112 ± 17 mmHg, p = 0.04) compared to controls, without changes in heart rate, central venous pressure and cardiac output. In addition, an increase of 86% in extravascular lung water (7.6 ± 0.6 ml/kg vs 14.1 ± 1.4 ml/ kg, p = 0.02) was reported, without changes in gas exchange and lung mechanics. Simultaneously, a slight increase in serum creatinine (1.12 ± 0.07 mg/dl vs 1.45 ± 0.10 mg/dl, p = 0.03) was described. Discussion: An early development of hemodynamic and pulmonary dysfunction was observed in this experimental reperfusion model. An increase in volumetric preload and blood pressure associated with a substantial increase in the extravascular lung water were also reported. It is essential serially monitor the hemodynamic and respiratory functions in AKI, including nonuremic subjects.
Notas
Indexación: Web of Science; Scielo
Palabras clave
Insuficiencia renal aguda, Función pulmonar, Isquemia renal, Hemodinamia, Acute kidney injury, Renal ischemia, Hemodynamics, Pulmonary function
Citación
Rev. chil. pediatr. vol.84 no.3 Santiago June 2013