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Comparison of the effects of lactated Ringer\'s or terlipressin resuscitation on renal function in an experimental model of hemorrhagic shock

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Author(s):
Leticia Urbano Cardoso de Castro
Total Authors: 1
Document type: Master's Dissertation
Press: São Paulo.
Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
Defense date:
Examining board members:
Lucia da Conceição Andrade; Luiz Marcelo Sá Malbouisson; Denise Aya Otsuki
Advisor: Lucia da Conceição Andrade
Abstract

Therapeutic strategies employed hemorrhagic shock (HS) resuscitation are able to prevent death, but its side effects can cause many organic dysfunction, including injury to the kidneys. It has been know that volume replacement with crystalloid solution can restore the hemodynamic status and decreases mortality; however, it can lead to organs and tissues edema, among other changes. Thus, the goal of this study was to compare the effects of resuscitation with lactated Ringer\'s (RL) or terlipressin (TLP) on renal function in an experimental model of HS. For this purpose, HS was induced in 20-30 kg swine, with pressure-controlled bleeding, to obtain and maintain the mean arterial pressure (MAP) of 40 mmHg for 30 minutes. The animals were divided into four groups, namely, the Sham group (made only the anesthetic procedure), Shock group (induction of hemorrhagic shock for 30 minutes) and the institution of resuscitation strategies: RL group (induction of hemorrhagic shock, and RL administration of three times the volume of removed blood) and TLP group (induction of shock and administration in bolus of 2 mg TLP). Hemodynamic parameters, renal and tubular function were evaluated at baseline; immediately after the HS; 30, 60, 90 and 120 minutes after treatment. At the end of the study, animals were euthanized after 60 or 120 minutes. Kidney tissue samples were collected for evaluation of histology and western blotting. We observed an improvement in microcirculation of animals treated with RL; however, there was a normalization of NKCC2 and aquaporin 2 protein expression in the TLP group. We observe that the kidney injury score was similar in both intervention groups, but Bax protein expression was more reduced than in the TLP group. We conclude that the TLP proved to be an effective strategy as RL in the rescue of hemorrhagic shock, with a likely potential for protect renal function (AU)