Post Emiel Hendrik, Su Fuhong, Hosokawa Koji, Taccone Fabio Silvio, Herpain Antoine, Creteur Jacques, De Backer Daniel, Vincent Jean-Louis
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
BMC Nephrol. 2017 May 31;18(1):182. doi: 10.1186/s12882-017-0586-6.
Perfusion deficits likely play an important role in the development of renal dysfunction in sepsis. Renal denervation may improve kidney perfusion and metabolism.
We randomized 14 female sheep to undergo bilateral surgical renal denervation (n = 7) or sham procedure (n = 7) prior to induction of sepsis. Renal blood flow (RBF) was measured with a pre-calibrated flowprobe. Laser Doppler probes were implanted to measure cortical and medullary perfusion. Cortical glucose, lactate and pyruvate levels were measured using the microdialysis technique. Creatinine clearance was determined. Sepsis was induced by peritonitis and fluid resuscitation was provided to avoid hypovolemia.
RBF and cortical perfusion were higher in the denervated group during the first 6 h after induction of sepsis (P < 0.001 and P < 0.05, respectively), while medullary perfusion decreased similarly in both groups. After hypotension developed, RBF decreased to similar levels in both groups. Cortical pyruvate and lactate levels were lower in the denervated animals (P < 0.001 and P < 0.001, respectively). There were no differences between groups in creatinine clearance, urine output or time to oliguria.
Denervation thus caused an early increase in RBF that was distributed towards the kidney cortex. Although associated with an attenuation of early cortical metabolic alterations, denervation failed to prevent the deterioration in renal function.
灌注不足可能在脓毒症所致肾功能障碍的发生中起重要作用。肾去神经支配可能改善肾脏灌注和代谢。
我们将14只雌性绵羊随机分为两组，在诱导脓毒症之前，7只接受双侧外科肾去神经支配手术，7只接受假手术。用预先校准的血流探头测量肾血流量（RBF）。植入激光多普勒探头以测量皮质和髓质灌注。使用微透析技术测量皮质葡萄糖、乳酸和丙酮酸水平。测定肌酐清除率。通过腹膜炎诱导脓毒症，并进行液体复苏以避免血容量不足。
在诱导脓毒症后的最初6小时内，去神经支配组的肾血流量和皮质灌注较高（分别为P < 0.001和P < 0.05），而两组的髓质灌注下降相似。发生低血压后，两组的肾血流量下降至相似水平。去神经支配动物的皮质丙酮酸和乳酸水平较低（分别为P < 0.001和P < 0.001）。两组在肌酐清除率、尿量或少尿时间方面无差异。
因此，去神经支配导致肾血流量早期增加，且增加的血流分布于肾皮质。尽管与早期皮质代谢改变的减轻相关，但去神经支配未能预防肾功能恶化。
