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The effect of phlebotomy and mannitol on acute renal injury induced by ischemia/reperfusion of lower limbs in rats.
Ann Vasc Surg. 2011 Nov; 25(8):1118-28.AV

Abstract

BACKGROUND

Abdominal aortic surgery can cause ischemic/reperfusion (I/R) injury not only in the lower limbs but also in remote organs such as kidneys. Venous blood volume exclusion from the inferior vena cava (phlebotomy) or/and mannitol are used as a treatment for I/R injury of kidney in humans, despite the fact that the effectiveness of these treatments is still debated. The aim of this study was to evaluate the effects of phlebotomy or/and mannitol on rat kidneys in a model of lower limbs I/R-induced acute renal injury (ARI).

MATERIAL AND METHODS

Thirty male Wistar albino rats were used and divided into five groups: (I) sham-operated group, laparotomy without I/R injury (group [S], n = 6); (II) I/R group, infrarenal aortic cross-clamp was used for lower limbs I/R, 3 hours of ischemia followed by 2 hours of reperfusion (group [I/R], n = 6); (III) I/R + phlebotomy group, identical to group [I/R] except for 1 mL of blood aspiration from the inferior caval vein just after ischemia (group [P], n = 6); (IV) I/R + mannitol-treated group, these rats were subjected to I/R and received a bolus injection of mannitol (group [M], n = 6); and (V) I/R + phlebotomy + mannitol-treated group (group [P + M], n = 6), the same procedures were performed as those described for previous groups. At the end of 2-hour reperfusion, all rats were sacrificed. Both kidneys were harvested for biochemical assay (myeloperoxidase [MPO] and superoxide dismutase [SOD] activities, and malondialdehyde [MDA] and reduced glutathione levels) and for histopathological examination (tubular necrosis and acute inflammation on kidney [ARI score]).

RESULTS

Aortic I/R significantly increased the level of MDA (reflecting lipid peroxidation), SOD (enzymatic endogenous antioxidant), and MPO (reflecting neutrophil infiltration) activity (p < 0.05). Phlebotomy or/and mannitol treatments significantly decreased the level of MDA, SOD, and MPO activity and increased glutathione level (nonenzymatic antioxidant in the kidney tissues) (p < 0.05). Histological evaluation of ARI score showed that aortic I/R significantly increased (p value for group [S] versus group [I/R] was 0.012), whereas phlebotomy or/and mannitol treatments significantly decreased tubular necrosis and inflammatory infiltration (p values for group [I/R] versus group [P], [M], and [P + M] were 0.043, 0.043, and 0.003, respectively).

CONCLUSION

This experiment clearly indicated that the lower limbs I/R-induced ARI attenuated significantly by phlebotomy or/and mannitol treatments. Phlebotomy plus mannitol is more effective treatment than phlebotomy or mannitol alone in preventing lower limbs I/R-induced ARI in rats. Further clinical studies are required to clarify whether phlebotomy or/and mannitol treatments are beneficial in alleviating of ARI during abdominal aortic surgery.

Authors+Show Affiliations

Department of Cardiovascular Surgery, School of Medicine, Pamukkale University, Denizli, Turkey. dr.igoksin@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22023943

Citation

Goksin, Ibrahim, et al. "The Effect of Phlebotomy and Mannitol On Acute Renal Injury Induced By Ischemia/reperfusion of Lower Limbs in Rats." Annals of Vascular Surgery, vol. 25, no. 8, 2011, pp. 1118-28.
Goksin I, Adali F, Enli Y, et al. The effect of phlebotomy and mannitol on acute renal injury induced by ischemia/reperfusion of lower limbs in rats. Ann Vasc Surg. 2011;25(8):1118-28.
Goksin, I., Adali, F., Enli, Y., Akbulut, M., Teke, Z., Sackan, G., Ocak, E., & Ozcan, A. V. (2011). The effect of phlebotomy and mannitol on acute renal injury induced by ischemia/reperfusion of lower limbs in rats. Annals of Vascular Surgery, 25(8), 1118-28. https://doi.org/10.1016/j.avsg.2011.07.007
Goksin I, et al. The Effect of Phlebotomy and Mannitol On Acute Renal Injury Induced By Ischemia/reperfusion of Lower Limbs in Rats. Ann Vasc Surg. 2011;25(8):1118-28. PubMed PMID: 22023943.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of phlebotomy and mannitol on acute renal injury induced by ischemia/reperfusion of lower limbs in rats. AU - Goksin,Ibrahim, AU - Adali,Fahri, AU - Enli,Yasar, AU - Akbulut,Metin, AU - Teke,Zafer, AU - Sackan,Gokhan, AU - Ocak,Erkin, AU - Ozcan,Ali Vefa, PY - 2011/02/03/received PY - 2011/07/21/revised PY - 2011/07/21/accepted PY - 2011/10/26/entrez PY - 2011/10/26/pubmed PY - 2012/2/18/medline SP - 1118 EP - 28 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 25 IS - 8 N2 - BACKGROUND: Abdominal aortic surgery can cause ischemic/reperfusion (I/R) injury not only in the lower limbs but also in remote organs such as kidneys. Venous blood volume exclusion from the inferior vena cava (phlebotomy) or/and mannitol are used as a treatment for I/R injury of kidney in humans, despite the fact that the effectiveness of these treatments is still debated. The aim of this study was to evaluate the effects of phlebotomy or/and mannitol on rat kidneys in a model of lower limbs I/R-induced acute renal injury (ARI). MATERIAL AND METHODS: Thirty male Wistar albino rats were used and divided into five groups: (I) sham-operated group, laparotomy without I/R injury (group [S], n = 6); (II) I/R group, infrarenal aortic cross-clamp was used for lower limbs I/R, 3 hours of ischemia followed by 2 hours of reperfusion (group [I/R], n = 6); (III) I/R + phlebotomy group, identical to group [I/R] except for 1 mL of blood aspiration from the inferior caval vein just after ischemia (group [P], n = 6); (IV) I/R + mannitol-treated group, these rats were subjected to I/R and received a bolus injection of mannitol (group [M], n = 6); and (V) I/R + phlebotomy + mannitol-treated group (group [P + M], n = 6), the same procedures were performed as those described for previous groups. At the end of 2-hour reperfusion, all rats were sacrificed. Both kidneys were harvested for biochemical assay (myeloperoxidase [MPO] and superoxide dismutase [SOD] activities, and malondialdehyde [MDA] and reduced glutathione levels) and for histopathological examination (tubular necrosis and acute inflammation on kidney [ARI score]). RESULTS: Aortic I/R significantly increased the level of MDA (reflecting lipid peroxidation), SOD (enzymatic endogenous antioxidant), and MPO (reflecting neutrophil infiltration) activity (p < 0.05). Phlebotomy or/and mannitol treatments significantly decreased the level of MDA, SOD, and MPO activity and increased glutathione level (nonenzymatic antioxidant in the kidney tissues) (p < 0.05). Histological evaluation of ARI score showed that aortic I/R significantly increased (p value for group [S] versus group [I/R] was 0.012), whereas phlebotomy or/and mannitol treatments significantly decreased tubular necrosis and inflammatory infiltration (p values for group [I/R] versus group [P], [M], and [P + M] were 0.043, 0.043, and 0.003, respectively). CONCLUSION: This experiment clearly indicated that the lower limbs I/R-induced ARI attenuated significantly by phlebotomy or/and mannitol treatments. Phlebotomy plus mannitol is more effective treatment than phlebotomy or mannitol alone in preventing lower limbs I/R-induced ARI in rats. Further clinical studies are required to clarify whether phlebotomy or/and mannitol treatments are beneficial in alleviating of ARI during abdominal aortic surgery. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/22023943/The_effect_of_phlebotomy_and_mannitol_on_acute_renal_injury_induced_by_ischemia/reperfusion_of_lower_limbs_in_rats_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(11)00356-6 DB - PRIME DP - Unbound Medicine ER -