Bedir Selhattin, Ma Yunbo, Antonelli Jodi, Cadeddu Jeffrey A, Gahan Jeffrey C
Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.
J Endourol. 2015 May;29(5):590-4. doi: 10.1089/end.2014.0563. Epub 2015 Apr 6.
Our study sought to demonstrate the effects of remote ischemic preconditioning (R-IPC) on renal function in a large animal (porcine) solitary-kidney model.
Twelve pigs were assigned to two groups: Each underwent a right nephrectomy followed by a week of recovery. Group 1 (No-IPC) underwent left renal hilar clamping for 90 minutes. Group 2 underwent right and left iliac artery clamping for 10 minutes each (R-IPC), followed by left hilar clamping for 90 minutes. Serum creatinine was drawn for both groups before ischemia (preoperative), then at 6 hours, 24 hours, 3 days, and 7 days after. Kidneys were harvested at 24 hours or 7 days for histologic analysis, and the degree of acute tubular necrosis (ATN) or lymphocyte invasion was quantified.
Paired serum creatinine values were analyzed between time points. For Group 1, paired differences existed at 24 hours (P=0.008) but not at 3 days or 7 days. For Group 2, paired differences existed at 24 hours (P=0.006) but not at 3 days or 7 days. The mean preoperative serum creatinine level was similar between groups (P>0.05). The change in serum creatinine level was not significantly different between groups at any time point. Histologic analysis revealed rare evidence of ATN at 24 hours in Group 2, but not in Group 1. At 7 days, neither group showed ATN, and both showed 1-2+evidence of lymphocytic infiltrates.
R-IPC in a solitary-kidney porcine model does not confer renal protection from warm ischemia either as evidenced by renal function measures or on histologic analysis.
我们的研究旨在证明远程缺血预处理（R-IPC）对大型动物（猪）单肾模型肾功能的影响。
将12头猪分为两组：每组均接受右肾切除术，随后恢复一周。第1组（非IPC组）左肾肾门阻断90分钟。第2组右、左髂动脉各阻断10分钟（R-IPC组），随后左肾门阻断90分钟。两组在缺血前（术前）、缺血后6小时、24小时、3天和7天采集血清肌酐。在24小时或7天时取肾进行组织学分析，对急性肾小管坏死（ATN）程度或淋巴细胞浸润进行量化。
分析各时间点之间的配对血清肌酐值。对于第1组，24小时时存在配对差异（P = 0.008），但3天和7天时不存在。对于第2组，24小时时存在配对差异（P = 0.006），但3天和7天时不存在。两组术前血清肌酐平均水平相似（P>0.05）。两组在任何时间点血清肌酐水平变化均无显著差异。组织学分析显示，第2组在24小时时有罕见的ATN证据，而第1组没有。在7天时，两组均未显示ATN，且均显示1-2+淋巴细胞浸润证据。
在单肾猪模型中，无论是从肾功能指标还是组织学分析来看，R-IPC均不能对肾脏提供免受热缺血损伤的保护作用。
