title: Preconditioning strategies for kidney ischemia reperfusion injury: implications of the "time-window" in remote ischemic preconditioning.
abstract: Remote ischemic preconditioning (IP) is a potential renoprotective strategy. However, there has been no demonstrated result in large animals and the role of time window in remote IP remains to be defined. Using a single-kidney porcine model, we evaluated organ protective function of remote IP in renal ischemia reperfusion injury. Fifteen Yorkshire pigs, 20 weeks old and weighing 35-38 kg were used. One week after left nephrectomy, we performed remote IP (clamping right external iliac artery, 2 cycles of 10 minutes) and right renal artery clamping (warm ischemia; 90 minutes). The animals were randomly divided into three groups: control group, warm ischemia without IP; group 1 (remote IP with early window [IP-E]), IP followed by warm ischemia with a 10-minute time window; and group 2 (remote IP with late window [IP-L]), IP followed by warm ischemia after a 24-hour time window. There were no differences in serum creatinine changes between groups. The IP-L group had lower urinary neutrophil gelatinase-associated lipocalin than control and IP-E at 72 hours post-ischemia. At 72 hours post-ischemia, the urinary kidney injury molecule-1 (KIM-1) was lower in the IP-L group than in the control and IP-E groups, and the IP-L group KIM-1 was near pre-ischemic levels, whereas the control and IP-E group KIM-1 levels were rising. Microalbumin also tended to be lower in the IP-L group. Taken together, remote IP showed a significant reduction in renal injury biomarkers from ischemia reperfusion injury. To effectively provide kidney protection, remote IP might require a considerable, rather than short, time window of ischemia.
authors: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Young Eun
authors: YE
authors: Yoon
authors: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Kwang Suk
authors: KS
authors: Lee
authors: Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea.
authors: Kyung Hwa
authors: KH
authors: Choi
authors: Department of Urology, Ewha Womans University Mokdong Hospital, Seoul, Korea.
authors: Kwang Hyun
authors: KH
authors: Kim
authors: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Seung Choul
authors: SC
authors: Yang
authors: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Woong Kyu
authors: WK
authors: Han
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000097:blood; D005260:Female; D019194:Ischemic Preconditioning; D007668:Kidney / Q000098:blood supply*; D015427:Reperfusion Injury / Q000517:prevention & control*; D013552:Swine
chemical_list: D015415:Biomarkers; D003404:Creatinine