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de Fallois J, Scharm R, Lindner TH, Scharf C, Petros S, Weidhase L. Kidney replacement and conservative therapies in rhabdomyolysis: a retrospective analysis. BMC Nephrol 2024; 25:96. [PMID: 38486159 PMCID: PMC10938657 DOI: 10.1186/s12882-024-03536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Toxic renal effects of myoglobin following rhabdomyolysis can cause acute kidney injury (AKI) with the necessity of kidney replacement therapy (KRT). Fast elimination of myoglobin seems notable to save kidney function and intensify kidney repair. Clinical data regarding efficacy of KRT in critical care patients with rhabdomyolysis and AKI are limited. This retrospective analysis aimed to identify differences between conservative therapy and different modalities of KRT regarding myoglobin elimination and clinical outcome. METHODS This systematic, retrospective, single-center study analyzed 328 critical care patients with rhabdomyolysis (myoglobin > 1000 µg/l). Median reduction rate of myoglobin after starting KRT was calculated and compared for different modalities. Multivariate logistic regression models were established to identify potential confounder on hospital mortality. Filter lifetime of the various extracorporeal circuits was analyzed by Kaplan-Meier curves. RESULTS From 328 included patients 171 required KRT. Health condition at admission of this group was more critical compared to patient with conservative therapy. Myoglobin reduction rate did not differ between the groups (KRT 49% [30.8%; 72.2%] vs. conservative treatment (CT) 61% [38.5%; 73.5%]; p = 0.082). Comparison between various extracorporeal procedures concerning mortality showed no significant differences. Hospital mortality was 55.6% among patients with KRT and 18.5% with CT (p < 0.001). Multivariate logistic regression model identified requirement for KRT (OR: 2.163; CI: 1.061-4.407); p = 0.034) and the SOFA Score (OR: 1.111; CI: 1.004-1.228; p = 0.041) as independent predictive factors for hospital mortality. When comparing specific KRT using multivariate regression, no benefit was demonstrated for any treatment modality. Life span of the extracorporeal circuit was shorter with CVVH compared to that of others (log-Rank p = 0.017). CONCLUSIONS This study emphasizes that AKI requiring KRT following rhabdomyolysis is accompanied by high mortality rate. Differences in myoglobin reduction rate between various KRTs could not be confirmed, but CVVH was associated with reduced filter lifetime compared to other KRTs, which enable myoglobin elimination, too.
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Affiliation(s)
- Jonathan de Fallois
- Medical Department III, Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Robert Scharm
- Medical Intensive Care Unit, Medical ICU, University of Leipzig Medical Center, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Tom H Lindner
- Medical Department III, Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Christina Scharf
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Sirak Petros
- Medical Intensive Care Unit, Medical ICU, University of Leipzig Medical Center, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Lorenz Weidhase
- Medical Intensive Care Unit, Medical ICU, University of Leipzig Medical Center, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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Meng Y, Zhou MX, Wu CB, Wang DH, Zhao JR, Shi DY. Continuous venovenous hemodiafiltration versus standard medical therapy for the prevention of rhabdomyolysis-induced acute kidney injury: a retrospective cohort study. BMC Nephrol 2023; 24:215. [PMID: 37468857 DOI: 10.1186/s12882-023-03242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
AIM To determine whether continuous venovenous hemodiafiltration (CVVHDF) plus standard medical therapy (SMT) vs. SMT alone prevents rhabdomyolysis (RM)-induced acute kidney injury (AKI) and analyze the related health economics. METHODS This retrospective cohort study involved 9 RM patients without AKI, coronary heart disease, or chronic kidney disease treated with CVVHDF plus SMT (CVVHDF + SMT group). Nine matched RM patients without AKI treated with SMT only served as controls (SMT group). Baseline characteristics, biochemical indexes, renal survival data, and health economic data were compared between groups. In the CVVHDF + SMT group, biochemical data were compared at different time points. RESULTS At 2 and 7 days after admission, serum biochemical indices (e.g., myoglobin, creatine kinase, creatinine, and blood urea nitrogen) did not differ between the groups. Total (P = 0.011) and daily hospitalization costs (P = 0.002) were higher in the CVVHDF + SMT group than in the SMT group. After 53 months of follow-up, no patient developed increased serum creatinine, except for 1 CVVHDF + SMT-group patient who died of acute myocardial infarction. In the CVVHDF + SMT group, myoglobin levels significantly differed before and after the first CVVHDF treatment (P = 0.008), and serum myoglobin, serum creatinine, and blood urea nitrogen decreased significantly at different time points after CVVHDF. CONCLUSIONS Although CVVHDF facilitated myoglobin elimination, its addition to SMT did not improve biochemical indices like serum myoglobin, serum creatine kinase, creatinine, blood urea nitrogen, and lactate dehydrogenase or the long-term renal prognosis. Despite similar hospitalization durations, both total and daily hospitalization costs were higher in the CVVHDF + SMT group.
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Affiliation(s)
- Yan Meng
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, PR China
| | - Ming-Xue Zhou
- Department of Nephrology, Chifeng Municipal Hospital, Chifeng, China
| | - Chun-Bo Wu
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, PR China
| | - De-Hua Wang
- Department of Interventional Medicine, the Fifth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Jian-Rong Zhao
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, PR China.
| | - Dong-Yin Shi
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, PR China.
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Li X, Bai M, Yu Y, Ma F, Zhao L, Li Y, Wu H, Zhou L, Sun S. Earlier continuous renal replacement therapy is associated with reduced mortality in rhabdomyolysis patients. Ren Fail 2022; 44:1743-1753. [PMID: 36259466 PMCID: PMC9586620 DOI: 10.1080/0886022x.2022.2132170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Continuous renal replacement therapy (CRRT) is commonly employed for rhabdomyolysis (RM) patients. However, the optimal initiation timing of CRRT and prognostic factors were not well evaluated for patients with RM. We aimed to investigate the efficacy of CRRT timing on mortality and the risk factors for death in RM patients who received CRRT. Methods RM patients who received CRRT between 1 May 2010 and 31 May 2021 in our center were retrospectively included. Univariate and multivariate logistic analyses were performed to identify the risk factors for primary outcome (90-day mortality). Results A total of 134 patients were included in our study. The 90-day mortality rate was 38.06%. The median time from CRRT initiation to peak CK occurrence was 4.8 h (IQR −16, 14), 67 patients received CRRT before 4.8 h after peak CK occurrence (early CRRT), and 67 patients received CRRT beyond 4.8 h after peak CK occurrence (late CRRT). Multivariate logistic regression analysis showed that the time from CRRT initiation to the peak CK (per 1 h, OR 1.026, 95% CI 1.004–1.049, p = 0.023), late CRRT (OR 3.082, 95% CI 1.072–8.859, p = 0.037), elevated serum cardiac troponin I (cTnI) (per 1 ng/mL, OR 1.218, 95% CI 1.011–1.468, p = 0.038), older age (per 1 year, OR 1.042, 95% CI 1.003–1.081, p = 0.032), and need of mechanical ventilation support (OR 4.632, 95% CI 1.292–16.61, p = 0.019) were independent risk factors for 90-day mortality. Conclusions Earlier CRRT initiation before 4.8 h after peak CK occurrence was associated with lower 90-day patient mortality.
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Affiliation(s)
- Xiayin Li
- Department of Postgraduate Student, Xi'an Medical University, Xi'an, China.,The Nephrology Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ming Bai
- The Nephrology Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yan Yu
- The Nephrology Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Feng Ma
- The Nephrology Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lijuan Zhao
- The Nephrology Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yajuan Li
- The Nephrology Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Hao Wu
- The Nephrology Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lei Zhou
- The Clinical Laboratory Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Shiren Sun
- The Nephrology Department of Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Experimental models of acute kidney injury for translational research. Nat Rev Nephrol 2022; 18:277-293. [PMID: 35173348 DOI: 10.1038/s41581-022-00539-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 12/20/2022]
Abstract
Preclinical models of human disease provide powerful tools for therapeutic discovery but have limitations. This problem is especially apparent in the field of acute kidney injury (AKI), in which clinical trial failures have been attributed to inaccurate modelling performed largely in rodents. Multidisciplinary efforts such as the Kidney Precision Medicine Project are now starting to identify molecular subtypes of human AKI. In addition, over the past decade, there have been developments in human pluripotent stem cell-derived kidney organoids as well as zebrafish, rodent and large animal models of AKI. These organoid and AKI models are being deployed at different stages of preclinical therapeutic development. However, the traditionally siloed, preclinical investigator-driven approaches that have been used to evaluate AKI therapeutics to date rarely account for the limitations of the model systems used and have given rise to false expectations of clinical efficacy in patients with different AKI pathophysiologies. To address this problem, there is a need to develop more flexible and integrated approaches, involving teams of investigators with expertise in a range of different model systems, working closely with clinical investigators, to develop robust preclinical evidence to support more focused interventions in patients with AKI.
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Hussain K, Xavier A. Rosuvastatin-related rhabdomyolysis causing severe proximal paraparesis and acute kidney injury. BMJ Case Rep 2019; 12:12/10/e229244. [PMID: 31601550 DOI: 10.1136/bcr-2019-229244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We describe the case of a 76-year-old man who presented with bilateral lower limb weakness associated with decreased urine output. His initial blood results showed acute kidney injury (AKI) stage 3 with substantially raised serum creatine kinase concentration of 37 950 IU/L (normal range <171 U/L). He had been on high-dose rosuvastatin for 4 years with a recent brand change occurring 1 week prior to onset of symptoms. There was no history of pre-existing neuromuscular disease. Statin-related rhabdomyolysis was suspected and rosuvastatin was withheld. His muscle strength gradually improved. He required haemodialysis for 10 weeks. He was discharged home after a complicated course of hospitalisation. His renal function improved and he became dialysis-independent; however, he was left with residual chronic kidney disease.
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Affiliation(s)
- Kosar Hussain
- General Medicine, Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Anil Xavier
- Nephrology and General Medicine, Goulburn Valley Health, Shepparton, Victoria, Australia
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Tseng MF, Chou CL, Chung CH, Chien WC, Chen YK, Yang HC, Liao CY, Wei KY, Wu CC. Continuous veno-venous hemofiltration yields better renal outcomes than intermittent hemodialysis among traumatic intracranial hemorrhage patients with acute kidney injury: A nationwide population-based retrospective study in Taiwan. PLoS One 2018; 13:e0203088. [PMID: 30235226 PMCID: PMC6157819 DOI: 10.1371/journal.pone.0203088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECT Traumatic intracranial hemorrhage (TICH) patients with acute kidney injury (AKI) were reported to have a high mortality rate. Renal replacement therapy (RRT) is indicated for patients with a severe kidney injury. This study aimed to compare the effects of different RRT modalities regarding chronic dialysis rate among adult TICH patients with AKI. METHODS A retrospective search of computerized hospital records from 2000 to 2010 for patients with a discharge diagnosis of TICH was conducted to identify the index cases. We collected the data of TICH patients with increased intracranial pressure combined with severe AKI who received intermittent hemodialysis (IHD) or continuous veno-venous hemofiltration (CVVH) as RRT. The outcome was dialysis dependence between 2000 and 2010. RESULTS From a total of 310 patients who were enrolled in the study, 134 (43%) received CVVH and 176 (57%) received IHD. The risk of dialysis dependency was significantly lower in the CVVH group than in the IHD group (adjusted hazard ratio: 0.368, 95% CI, 0.158-0.858, P = 0.034). Diabetes mellitus and coronary artery disease were risk factors for dialysis dependency. CVVH compared with IHD modality was associated with lower dialysis dependency rate in TICH patients combined with AKI and diabetes mellitus and those with an injury severity score (ISS) ≥16. CONCLUSION CVVH may yield better renal outcomes than IHD among TICH patients with AKI, especially those with diabetes mellitus and an ISS ≥16. The beneficial impact of CVVH on TICH patients needs to be clarified in a large cohort study in future.
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Affiliation(s)
- Min-Feng Tseng
- Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chu-Lin Chou
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ying-Kai Chen
- Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Chien Yang
- Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chen-Yi Liao
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Kuang-Yu Wei
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Chao Wu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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7
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The role of complement activation in rhabdomyolysis-induced acute kidney injury. PLoS One 2018; 13:e0192361. [PMID: 29466390 PMCID: PMC5821337 DOI: 10.1371/journal.pone.0192361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/20/2018] [Indexed: 12/25/2022] Open
Abstract
Rhabdomyolysis (RM) may cause kidney damage and results primarily in acute kidney injury (AKI). Complement is implicated in the pathogenesis of renal diseases and ischemia-reperfusion injury (IRI), but the role of complement, especially its activation pathway(s) and its effect in RM-induced AKI, is not clear. This study established a rat model of AKI induced by RM via intramuscular treatment with glycerol. Cobra venom factor (CVF) was administered via tail vein injection to deplete complement 12 h prior to intramuscular injection of glycerol. We found that the complement components, including complement 3 (C3), C1q, MBL-A, factor B(fB), C5a, C5b-9, and CD59, were significantly increased in rat kidneys after intramuscular glycerol administration. However, the levels of serum BUN and Cr, renal tubular injury scores, and the number of TUNEL-positive cells decreased significantly in the CVF+AKI group. These results suggest that complement plays an important role in RM-induced AKI and that complement depletion may improve renal function and decrease renal tissue damage by reducing the inflammatory response and apoptosis.
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Beitland S, Nakstad ER, Staer-Jensen H, Draegni T, Andersen GØ, Jacobsen D, Brunborg C, Waldum-Grevbo B, Sunde K. Impact of acute kidney injury on patient outcome in out-of-hospital cardiac arrest: a prospective observational study. Acta Anaesthesiol Scand 2016; 60:1170-81. [PMID: 27306254 DOI: 10.1111/aas.12753] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/12/2016] [Accepted: 05/03/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Kidney disease after out-of-hospital cardiac arrest (OHCA) is incompletely described. We examined the occurrence of acute kidney injury (AKI) in OHCA patients and impact of AKI, with or without renal replacement therapy (RRT), on 6-month mortality and neurological outcome. METHODS Prospective study at Oslo University Hospital, Oslo, Norway. Adult resuscitated comatose OHCA patients treated with targeted temperature management at 33°C for 24 h were included. AKI and chronic kidney disease (CKD) were classified according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Main outcomes were 6-month mortality and good neurological outcome defined as Cerebral Performance Category 1-2. RESULTS Among 245 included patients (84% males, mean age 61 years), 11 (4%) had previously known CKD and 112 (46%) developed AKI. Overall 6-month outcome revealed that 112 (46%) died and 123 (50%) had good neurological outcome. Compared with no kidney disease, the presence of AKI was significantly associated with 6-month mortality (odds ratio (OR) 3.17, 95% confidence interval (CI) 1.95-5.43, P < 0.001) and good neurological outcome (OR 0.28, 95% CI 0.16-0.48, P < 0.001). Six-month mortality (50 vs. 61%, P = 0.401) and frequency of good neurological outcome (44 vs. 35%, P = 0.417) were not statistically different in AKI patients with or without RRT, also after excluding patients where RRT was withheld due to futility. CONCLUSIONS Kidney disease occurred in about half of patients successfully resuscitated from OHCA. Presence of AKI, but not RRT, was associated with unfavourable 6-month outcome.
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Affiliation(s)
- S. Beitland
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Anaesthesiology; Oslo University Hospital Ullevål; Oslo Norway
| | - E. R. Nakstad
- Norwegian National unit for CBRNe Medicine; Oslo University Hospital Ullevål; Oslo Norway
| | - H. Staer-Jensen
- Department of Anaesthesiology; Oslo University Hospital Ullevål; Oslo Norway
| | - T. Draegni
- Department of Research and Development; Oslo University Hospital Ullevål; Oslo Norway
| | - G. Ø. Andersen
- Depertment of Cardiology; Oslo University Hospital Ullevål; Oslo Norway
| | - D. Jacobsen
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
- Norwegian National unit for CBRNe Medicine; Oslo University Hospital Ullevål; Oslo Norway
- Department of Acute Medicine; Oslo University Hospital Ullevål; Oslo Norway
| | - C. Brunborg
- Oslo Centre for Biostatistics and Epidemiology; Research Support Services; Oslo University Hospital; Oslo Norway
| | - B. Waldum-Grevbo
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Nephrology; Oslo University Hospital Ullevål; Oslo Norway
| | - K. Sunde
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Anaesthesiology; Oslo University Hospital Ullevål; Oslo Norway
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Zhao W, Huang X, Zhang L, Yang X, Wang L, Chen Y, Wang J, Wu G. Penehyclidine Hydrochloride Pretreatment Ameliorates Rhabdomyolysis-Induced AKI by Activating the Nrf2/HO-1 Pathway and Alleviating [corrected] Endoplasmic Reticulum Stress in Rats. The. PLoS One 2016; 11:e0151158. [PMID: 26987113 PMCID: PMC4795801 DOI: 10.1371/journal.pone.0151158] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/24/2016] [Indexed: 12/18/2022] Open
Abstract
Acute kidney injury (AKI) is one of the most severe complications of rhabdomyolysis (RM). The underlying mechanisms and potential preventions need to be investigated. Penehyclidine hydrochloride (PHC) was reported to ameliorate renal ischemia-reperfusion injury, but the effect of PHC on RM-reduced AKI is unknown. In this study, we established a rat model of RM-induced AKI using an intramuscular glycerol injection in the hind limbs. Rats were pretreated with PHC before the glycerol injection, and the heme oxygenase-1 (HO-1) inhibitor ZnPP was introduced to evaluate the effect of HO-1 on RM-induced AKI. PHC pretreatment ameliorated the pathological renal injury and renal dysfunction, and decreased the renal apoptosis rate in RM-induced AKI. PHC significantly up-regulated HO-1 expression, increased HO-1 enzymatic activity and decreased the accumulation of myoglobin in renal tissues. This effect was partly inhibited by ZnPP. PHC pretreatment also effectively up-regulated nuclear factor erythroid 2-related factor 2 (Nrf2) and down-regulated glucose regulated protein 78 (GRP78) and caspase-12 at both the gene and protein levels. These results suggest that the protective effects of PHC pretreatment on RM-induced AKI occur at least in part through activating the Nrf2/HO-1 pathway and alleviating endoplasmic reticulum stress (ERS) in rat renal tissues.
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Affiliation(s)
- Wei Zhao
- Department of Nephrology, Chinese PLA General Hospital, Beijing, the People’s Republic of China
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - XuDong Huang
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - LiXia Zhang
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - XinJun Yang
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - LiHui Wang
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - YunShuang Chen
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - JingHua Wang
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
| | - GuangLi Wu
- Department of Nephrology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, the People’s Republic of China
- * E-mail:
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Homsi E, Andreazzi DD, Faria JBLD, Janino P. TNF-α-mediated cardiorenal injury after rhabdomyolysis in rats. Am J Physiol Renal Physiol 2015; 308:F1259-67. [DOI: 10.1152/ajprenal.00311.2014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/21/2014] [Indexed: 01/12/2023] Open
Abstract
The TNF-α serum level increases after rhabdomyolysis and is involved in the subsequent cardiorenal injury. In the present study, we investigated the TNF-α-dependent cell signaling pathways implicated in cellular injury in these organs. Rhabdomyolysis was induced by intramuscular glycerol injection in rats. Renal function, cardiac and renal pathology, and activation of caspases were evaluated during the first 24 h after glycerol injection. TNF-α blockade with infliximab reduced tubular necrosis and cardiorenal apoptosis. Cellular Fas-associated protein with death domain-like IL-1β-converting enzyme inhibitory protein (cFLIP), an inhibitor of caspase-8, was overexpressed in the kidney but not in the heart. The inhibitory effect of cFLIP blunted caspase-8 activation in the kidney. In this condition, the cellular response to the TNF-α stimulus was driven to receptor-interacting protein-1 (RIP1)-mediated necroptosis. Treatment with RIP1 inhibitor (necrostatin-1) isolated or in combination with infliximab showed a similar reduction in tubular necrosis, underscoring the importance of TNF-α-mediated tubular necroptosis in this model. TNF-α played a positive regulatory role in the transcription of proapoptotic Bax and p53-upregulated modulator of apoptosis (PUMA) proteins. Infliximab treatment reduced caspase-9-mediated apoptosis in both organs. Treatment with a caspase-8 inhibitor showed that caspase-8 participated in the process of apoptosis only in the heart, upstream of caspase-9 activation. TNF-α-mediated necroptosis is the predominant form of tubular injury observed in the glycerol model. TNF-α up regulates Bax and PUMA proapoptotic proteins, resulting in activation of the intrinsic pathway of apoptosis in the kidney and heart.
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Affiliation(s)
- Eduardo Homsi
- Division of Nephrology, Department of Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - Diego Duarte Andreazzi
- Division of Nephrology, Department of Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - Jose Butori Lopes de Faria
- Division of Nephrology, Department of Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
| | - Patrícia Janino
- Division of Nephrology, Department of Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil
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Petejova N, Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:224. [PMID: 25043142 PMCID: PMC4056317 DOI: 10.1186/cc13897] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Rhabdomyolysis, a clinical syndrome caused by damage to skeletal muscle and release of its breakdown products into the circulation, can be followed by acute kidney injury (AKI) as a severe complication. The belief that the AKI is triggered by myoglobin as the toxin responsible appears to be oversimplified. Better knowledge of the pathophysiology of rhabdomyolysis and following AKI could widen treatment options, leading to preservation of the kidney: the decision to initiate renal replacement therapy in clinical practice should not be made on the basis of the myoglobin or creatine phosphokinase serum concentrations.
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Abstract
In this Editor's Review, articles published in 2013 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level". Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide so meaningful suggestions to the author's work whether eventually accepted or rejected and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, Wiley Periodicals, for their expert attention and support in the production and marketing of Artificial Organs. We look forward to recording further advances in the coming years.
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