The impact of crystalloid and colloid infusion on the kidney in rodent sepsis.
OBJECTIVE
Volume replacement remains one of the pillars of sepsis therapy. The effect of different volume solutions on kidney function in sepsis still remains unclear. We therefore determined the impact of crystalloid and colloid solutions on kidney function in a rodent model of abdominal sepsis induced by cecal ligation and puncture (CLP).


METHODS
Anesthetized rats underwent the CLP procedure, whereas control animals were sham operated. Septic animals were treated with crystalloid and colloid solutions. Hemodynamic variables and blood gases were measured. After 24 h animals were re-anesthetized, the kidneys were harvested, and creatinine (crea), urea, cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) were investigated.


RESULTS
Septic animals exhibited a mortality rate of 19% after 24 h. Gelatin-treated animals showed significantly increased levels of crea and urea. Colloids [gelatin 4% (Gel) or hydroxyethyl starch 6% 130/0.4 (HES)] as volume replacement resulted in elevated levels of NGAL. The histopathological observations revealed that Gel- and HES-treated animals showed vesicles within epithelial cells of the tubulus system and an overall increased injury. In contrast, total injury scores in groups treated with crystalloids [0.9% NaCl (NaCl) and Sterofundin ISO (SteroIso)] were not significantly different compared to sham-treated animals.


CONCLUSIONS
None of the examined volume solution was inert to the kidney. In a CLP rodent sepsis model, animals infused with balanced crystalloid SteroIso exhibited the least effects on kidney function. Both hydroxyethyl starch 6% 130/0.4 and gelatin 4% derogated the kidney, whereas gelatin was more harmful when compared with hydroxyethyl starch.
Schick
Martin Alexander
MA
Klinik und Poliklinik für Anästhesiologie, Zentrum für Operative Medizin, University of Würzburg, Oberdürrbacherstrasse 6, 97080 Würzburg, Germany.
Isbary
Tobias Jobst
TJ
Schlegel
Nicolas
N
Brugger
Juergen
J
Waschke
Jens
J
Muellenbach
Ralf
R
Roewer
Norbert
N
Wunder
Christian
C
D000209:Acute-Phase Proteins; D000818:Animals; D003102:Colloids / Q000008:administration & dosage* / Q000494:pharmacology; D003404:Creatinine / Q000097:blood; D000077324:Crystalloid Solutions; D055316:Cystatin C / Q000097:blood; D005780:Gelatin / Q000008:administration & dosage; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000494:pharmacology; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000494:pharmacology; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood; D011518:Proto-Oncogene Proteins / Q000097:blood; D051381:Rats; D051437:Renal Insufficiency / Q000097:blood / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D018805:Sepsis / Q000150:complications* / Q000503:physiopathology
D000209:Acute-Phase Proteins; D003102:Colloids; D000077324:Crystalloid Solutions; D055316:Cystatin C; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; C097278:Lcn2 protein, rat; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D005780:Gelatin; D003404:Creatinine