The renal effect of replacement fluids in controlled severe hemorrhagic shock: an experimental study

BACKGROUND
This experimental study examined the effects of resuscitation with Ringer’s lactate (RL), 6% hydroxyethyl starch (130/0.4-HES), and the combination of RL and HES on renal function in hemorrhagic shock (HS).
METHODS
Twenty-four male New Zealand white rabbits weighing 2198-3435 g were divided at random into four groups. HS was constituted by maintaining the mean arterial blood pressure at 30 mmHg and blood lactate at >4 mM/L. Subsequently, Group 1 (control) was not resuscitated, while the study rabbits’ resuscitation was initiated with RL (Group 2), HES (Group 3), or the combination of RL and HES (Group 4).
RESULTS
In all groups, the serum creatinine and blood urea nitrogen (BUN) levels were observed to be within normal limits, while the lactate dehydrogenase and α-1 microglobulin levels statistically significantly increased when time points were compared with beginning values (p<0.05). Furthermore, cystatin-C levels were observed to be increased after the HS (p<0.05), but returned to the normal level after resuscitation in all the study groups. Interleukin (IL)-6 and tumor necrosis factor (TNF)-α levels were increased in all the rabbits after HS (p<0.05), and there were no significant differences among the study groups after resuscitation (p>0.05). There were no differences in the histological imaging between the groups (p>0.05).
CONCLUSION
The 6% HES (130/0.4) did not have any harmful effects on the kidney when it was used alone or in combination with crystalloid for resuscitation of HS in rabbits.

Kontrollü ciddi hemorajik þokta replasman sývýlarýnýn böbreklere etkileri: Deneysel araþtýrma

AMAÇ
Bu deneysel araþtýrmada, hemorajik þokta Ringer laktat (RL), %6’lýk hidroksietil niþasta (130/0,4-HES) ve RL-HES kombinasyonu ile resüsitasyonun böbrekler üzerine etkileri araþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmada aðýrlýklarý 2198-3435 g olan 24 adet erkek Yeni Zelanda beyaz tavþaný rastgele dört gruba ayrýldý. Hemorajik þok, ortalama arter basýncý 30 mmHg ve kan laktatý >4 mM/L olacak þekilde oluþturuldu. Grup 1’de sývý replasmaný uygulanmaz iken, Grup 2’de RL, Grup 3’te HES ve Grup 4’te de RL+HES ile sývý replasmaný ile þok düzeltildi.
BULGULAR
Bütün gruplarda, serum kreatinin ve kan üre azotu düzeyleri hemorajik þoktan ve sývý resüsitasyonundan sonra normal sýnýrlarda kaldý. Laktat dehidrogenaz ve a-1 mikroglobulin düzeyleri þoktan ve sývý resüsitasyonundan sonra anlamlý olarak arttý (p<0,05). Ancak, gruplar arasýnda bir fark yoktu (p>0,05). Sistatin-C düzeyleri þoktan sonra artmasýna karþýn (p<0,05) sývý replasmaný ile normal deðerlere geri geldi. IL-6 ve TNF-a düzeyleri þoktan sonra bütün deneklerde arttý (p<0,05). Ancak, sývý replasmanýndan sonra gruplar arasýnda bir fark gözlenmedi (p>0,05). Böbreklerin histopatolojik incelemelerinde gruplar arasýnda bir fark bulunmadý (p>0,05).
SONUÇ
%6’lýk HES (130/0,4), gerek tek baþýna gerekse RL ile beraber hemorajik þokun tedavisinde kullanýldýðýnda tavþan böbrekleri üzerine zararlý bir etkisi olmadý.