International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.
Department of Anaesthesia and Intensive Care, Catholic University, Rome, Italy.
Nephrol Dial Transplant. 2017 Feb 1;32(2):241-247. doi: 10.1093/ndt/gfw038.
Cellular damage after reperfusion of ischaemic tissue is defined as ischaemia–reperfusion injury (IRI). Hypothermia is able to decrease oxygen consumption, preventing a rapid loss of mitochondrial activity. However, even though cooling can help to decrease the deleterious effects of ischaemia, the consequences are not exclusively beneficial, such that hypothermic storage is a compromise between benefits and harm. The present review details the relationship between renal IRI and hypothermia, describing the pathophysiology of IRI and hypothermic protection through experimental evidence. Although experimental models of renal IRI are a valuable tool for understanding the pathophysiology of renal ischaemia–reperfusion, the clinical transfer of experimental results has several limitations, particularly because of anatomical and physiological differences. In this review limitations of animal models but also hypothermia as a strategy to protect the kidney from IRI are discussed. We also attempt to describe three clinical scenarios where hypothermia is used in clinical settings of IRI: transplantation, deceased donors and post-cardiac arrest.
缺血组织再灌注后的细胞损伤被定义为缺血再灌注损伤（IRI）。低温能够降低耗氧量，防止线粒体活性的迅速丧失。然而，尽管冷却有助于减少缺血的有害影响，但结果并非完全有益，因此低温保存是在益处和危害之间的妥协。本综述详细描述了肾脏 IRI 与低温之间的关系，通过实验证据描述了 IRI 的病理生理学和低温保护。尽管肾脏 IRI 的实验模型是理解肾脏缺血再灌注病理生理学的有价值的工具，但实验结果的临床转化存在几个局限性，特别是由于解剖学和生理学的差异。在本综述中，讨论了动物模型的局限性以及低温作为保护肾脏免受 IRI 的策略。我们还试图描述低温在 IRI 的三种临床情况下的应用：移植、已故供体和心脏骤停后。
