Weld Kyle J, Evearitt Kristin, Dixon Patricia, Cespedes R Duane
Departments of Urology and Clinical Research, Wilford Hall Medical Center, Lackland Air Force Base, Texas 78236, USA.
J Urol. 2009 Feb;181(2):878-83. doi: 10.1016/j.juro.2008.10.068. Epub 2008 Dec 17.
Microdialysis is a technique for monitoring the concentration of molecules in the interstitial fluid of living tissue. We report the effects of ischemia on human renal interstitial fluid molecules.
Ten patients with a renal mass or upper tract transitional cell carcinoma who elected laparoscopic nephrectomy or nephroureterectomy were studied with in situ renal microdialysis. Microdialysate was continuously collected into separate vials every 10 minutes before and after the renal artery was stapled. Samples were analyzed for the glucose, pyruvate, lactate and glycerol concentration.
The concentration of all 4 molecules was stable throughout the pre-ischemia baseline period. Glucose and pyruvate concentrations decreased to almost zero during the first 60 minutes of ischemia. Lactate increased during the initial 60 minutes of ischemia and then plateaued with continued ischemia. The glycerol concentration increased directly throughout the ischemia time.
The trends of human interstitial metabolite concentrations during ischemia are similar to trends found in the porcine model. The human renal interstitial glycerol concentration increases directly throughout the duration of ischemia and serves as a marker of nephron damage. Microdialysis is a tool that provides real-time, renal unit specific, minimally invasive data on the metabolic status of the human kidney during ischemia. It may be helpful for avoiding permanent renal ischemic injury.
微透析是一种监测活体组织间质液中分子浓度的技术。我们报告了缺血对人肾间质液分子的影响。
对10例选择腹腔镜肾切除术或肾输尿管切除术治疗肾肿物或上尿路移行细胞癌的患者进行原位肾微透析研究。在肾动脉结扎前后，每10分钟将微透析液连续收集到单独的小瓶中。分析样本中的葡萄糖、丙酮酸、乳酸和甘油浓度。
在缺血前的基线期，所有4种分子的浓度均保持稳定。在缺血的最初60分钟内，葡萄糖和丙酮酸浓度降至几乎为零。乳酸在缺血最初60分钟内升高，然后在持续缺血时趋于平稳。甘油浓度在整个缺血期间持续直接升高。
缺血期间人间质代谢物浓度的变化趋势与猪模型中的趋势相似。人肾间质甘油浓度在整个缺血期间持续直接升高，可作为肾单位损伤的标志物。微透析是一种能提供缺血期间人肾代谢状态实时、肾单位特异性、微创数据的工具。它可能有助于避免永久性肾缺血损伤。
