Renal assessment after volume resuscitation with Steen Solution or albumin in experimental model of hypovolemic shock

Abstract

Hypovolemic shock is treated at intensive care unit using replacement solution such as 0,9% saline solution and ringer lactate. However, these solutions can be harmful to many organs used for transplantation. Kidney plays an important role in regulating blood pressure by activating the renin-angiotensin mechanism and vasoconstriction, which leads indirectly to the release of aldosterone from the suprarenal cortex, promoting retention of sodium and water. The increased sodium concentration in the blood stimulates the release of the antidiuretic hormone (ADH) from the pituitary gland. The ADH into the bloodstream and causes the kidneys to retain water by concentrating the urine and reducing urine volume. Water retention increases blood volume by raising blood pressure. When the mean blood pressure drops to very low levels, the glomerular filtration rate of the kidneys can not be maintained, leading to acute insufficiency. Generating a decreased urine output to less than 0.5 ml / kg per hour (or below 30 ml per hour).This project is part of an interdisciplinary study developed by Thoracic Surgery Departament and Nephrology Departament of FMUSP to evaluate the impact of volume replacement with Steen Solution® or albumin in the lungs and kidneys. The aim of this project is to evaluate the impact of volume replacement with Steen Solution® and Albumin in an experimental donor model of hypovolemic shock in kidneys.For this, we designed an experimental study with 40 animals alocated in 4 groups:Hypovolemic Shock Group (n=10): animals induced to hypovolemic shock.Hypovelmic Shock Group + Steen solution (n=10): Animals induced to hypovolemic shock and treated by slow infusions of Steen Solution.Hypovolemic Shock Group + Albumin (n=10): animals induced to hypovolemic shock and treated by slow infusions of Albumin.SHAM Group (n=10): Animals with no induction to shock or any kind of volemic shock.The hemorrhagic shock model will be induced by blood withdrawal in successive aliquots until the animal reaches MAP of 40 mmHg. The intravenous treatment with Steen Solution 4 ml / kg or with Albumin 20% 4 ml / kg will be performed after 60 minutes of the induction of femoral hemorrhagic shock. After treatment the rats were evaluated for 120 minutes, then they were sacrificed. Renal function through the quantification of creatinine in the urine, creatinine and serum urea and immunohistochemistry wll be evaluated.