RT Journal Article
SR Electronic
T1 Vasopressin analog terlipressin attenuates kidney injury in hemorrhagic shock
JF Trauma Surgery & Acute Care Open
FD BMJ Publishing Group Ltd
SP e000039
DO 10.1136/tsaco-2016-000039
VO 1
IS 1
A1 Letícia Urbano Cardoso de Castro
A1 Keila Kazue Ida
A1 Denise Aya Otsuki
A1 Talita Rojas Sanches
A1 Rildo A Volpini
A1 Emilyn da Silva Borges
A1 Luiz-Marcelo Sá Malbouisson
A1 Lúcia Andrade
YR 2016
UL http://tsaco.bmj.com/content/1/1/e000039.abstract
AB Background In hemorrhagic shock (HS), volume replacement with crystalloid solution can restore the hemodynamic status and decrease mortality. However, it can also lead to tissue edema and pulmonary congestion, as well as increasing vascular permeability. Here, we analyzed the effects that resuscitation with lactated Ringer's solution (LRS) or administration of the vasopressin analog terlipressin has on renal function in a porcine model of HS.Methods Using pressure-controlled bleeding, we induced pigs to HS, maintaining mean arterial pressure (MAP) at 40 mm Hg for 30 min. Animals were divided into 4 groups: sham (anesthesia only); shock-only (HS induction); shock+LRS (HS induction and subsequent resuscitation with LRS at 3 times the volume of blood removed); and shock+Terli (HS induction and subsequent bolus administration of 2 mg of terlipressin). Parameters were evaluated at baseline, then at 30, 60, and 120 min after treatment (T30, T60, and T120, respectively). Animals were euthanized at T60 or T120.Results Both treatments restored MAP to baseline values. At T30 and T60, creatinine clearance was highest in shock+LRS pigs, whereas it was highest in shock+Terli pigs at T120. Both treatments initially induced hyponatremia, although urinary excretion of all ions was higher in shock+LRS pigs at T30. Both treatments restored Na–K–2Cl cotransporter expression, whereas only terlipressin restored aquaporin 2 expression. Both treatments also prevented HS-induced acute tubular necrosis. Expression of the vasopressin receptors V1a and V2 was highest in shock-only pigs. At T120, V1a expression was lowest in shock+LRS pigs.Discussion Terlipressin might be useful for preventing HS-induced acute kidney injury.