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 alpha-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)-alpha 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).


CONCLUSIONS
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.
Department of 2nd Anesthesiology and Reanimation Clinic, Atatürk Training and Research Hospital, Izmir, Turkey. tadanir@tnn.net
Tayfun
T
Adanir
Murat
M
Aksun
Mustafa
M
Cirit
Funda
F
Alkan Taşli
Osman
O
Sahin
Mert
M
Kestelli
Tuba
T
Aydin Kantaroğlu
Mehmet
M
Köseoğlu
Atilla
A
Sencan
Nagihan
N
Karahan
D000818:Animals; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D004195:Disease Models, Animal; D005440:Fluid Therapy / Q000379:methods*; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D007552:Isotonic Solutions / Q000494:pharmacology*; D007668:Kidney / Q000187:drug effects* / Q000502:physiology; D008297:Male; D010952:Plasma Substitutes / Q000494:pharmacology*; D020011:Protective Agents; D011817:Rabbits; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods; D000077325:Ringer's Lactate; D012771:Shock, Hemorrhagic / Q000150:complications / Q000628:therapy*
D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D020011:Protective Agents; D000077325:Ringer's Lactate; D003404:Creatinine