title: Preconditioning renoprotective effect of isoflurane in a rat model of virtual renal transplant.
abstract: BACKGROUND
  The development of warm-cold ischemia-reperfusion (IR) injury of the kidney grafts is inevitable during renal transplantation. However, there is currently no definite renoprotective strategy available in the protection of the graft tissue. In the present study, we compared the renal protection of preconditioning isoflurane with N-acetylcysteine (NAC) in a novel rat model of warm-cold renal IR injury.
  
  
  METHODS
  Adult Sprague-Dawley rats were randomly assigned to receive inhaled isoflurane (1.5% for 2 h), NAC (1 g/kg, intra-arterial injection) or placebo before the induction of brief warm ischemia (10 min) followed by cold ischemia (45 min) periods. Plasma levels of creatinine and tissue inflammatory reaction in the kidney were analyzed 72 h after reperfusion.
  
  
  RESULTS
  Elevated plasma level of creatinine and urea indicated the development of acute renal injury secondary to IR injury. The creatinine levels were reduced in animals pretreated with inhaled isoflurane and NAC, and the level was more significantly decreased in the isoflurane-treated group. Preconditioning with volatile isoflurane also significantly suppressed the tissue myeloperoxidase activity and expression of the inducible nitric oxide synthase. Immunostaining confirmed that myeloperoxidase expression was most significantly attenuated in the glomerulus and peritubular capillaries of rats pre-exposed to isoflurane.
  
  
  CONCLUSIONS
  We present the first study demonstrating that the administration of volatile isoflurane before induction of experimental warm-cold renal IR injury provides preconditioning renoprotective effect, which is superior to the treatment with NAC. The beneficial renoprotective effect of isoflurane is most likely mediated by attenuation of proinflammatory reaction in the injured kidney.
authors.affiliation: Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.
authors.forename: Min-Wen
authors.initials: MW
authors.lastname: Su
authors.affiliation: Department of Surgery, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.
authors.forename: Shen-Shin
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.
authors.forename: Chung-Hao
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.
authors.forename: Chien-Chi
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.
authors.forename: Shih-Wei
authors.initials: SW
authors.lastname: Chang
authors.affiliation: Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.
authors.forename: Yu-Chuan
authors.initials: YC
authors.lastname: Tsai
authors.affiliation: Department of Anesthesiology, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan; Department of Anesthesiology, Buddhist Tzu-Chi General Hospital and Tzu-Chi University School of Medicine, Hualien, Taiwan. Electronic address: lamcf@tzuchi.com.tw.
authors.forename: Chen-Fuh
authors.initials: CF
authors.lastname: Lam
mesh_terms: D000111:Acetylcysteine / Q000494:pharmacology / Q000627:therapeutic use; D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D018685:Anesthetics, Inhalation / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D016166:Free Radical Scavengers / Q000494:pharmacology / Q000627:therapeutic use; D019194:Ischemic Preconditioning / Q000379:methods*; D007530:Isoflurane / Q000494:pharmacology / Q000627:therapeutic use*; D007668:Kidney / Q000098:blood supply* / Q000187:drug effects; D016030:Kidney Transplantation / Q000009:adverse effects; D023421:Models, Animal; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*
chemical_list: D018685:Anesthetics, Inhalation; D016166:Free Radical Scavengers; D007530:Isoflurane; D000111:Acetylcysteine
keywords: Delayed graft function; Inflammation; Inhaled anesthetics; Ischemia–reperfusion injury; Renal transplantation