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Effects of N -acetylcysteine (NAC) supplementation in resuscitation fluids on renal microcirculatory oxygenation, inflammation, and function in a rat model of endotoxemia

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ABSTRACT

Background: Modulation of inflammation and oxidative stress appears to limit sepsis-induced damage in experimental models. The kidney is one of the most sensitive organs to injury during septic shock. In this study, we evaluated the effect of N-acetylcysteine (NAC) administration in conjunction with fluid resuscitation on renal oxygenation and function. We hypothesized that reducing inflammation would improve the microcirculatory oxygenation in the kidney and limit the onset of acute kidney injury (AKI).

Methods: Rats were randomized into five groups (n = 8 per group): (1) control group, (2) control + NAC, (3) endotoxemic shock with lipopolysaccharide (LPS) without fluids, (4) LPS + fluid resuscitation, and (5) LPS + fluid resuscitation + NAC (150 mg/kg/h). Fluid resuscitation was initiated at 120 min and maintained at fixed volume for 2 h with hydroxyethyl starch (HES 130/0.4) dissolved in acetate-balanced Ringer’s solution (Volulyte) with or without supplementation with NAC (150 mg/kg/h). Oxygen tension in the renal cortex (CμPO2), outer medulla (MμPO2), and renal vein was measured using phosphorimetry. Biomarkers of renal injury, inflammation, and oxidative stress were assessed in kidney tissues.

Results: Fluid resuscitation significantly improved the systemic and renal macrohemodynamic parameters after LPS. However, the addition of NAC further improved cortical renal oxygenation, oxygen delivery, and oxygen consumption (p < 0.05). NAC supplementation dampened the accumulation of NGAL or L-FABP, hyaluronic acid, and nitric oxide in kidney tissue (p < 0.01).

Conclusion: The addition of NAC to fluid resuscitation may improve renal oxygenation and attenuate microvascular dysfunction and AKI. Decreases in renal NO and hyaluronic acid levels may be involved in this beneficial effect. A therapeutic strategy combining initial fluid resuscitation with antioxidant therapies may prevent sepsis-induced AKI.

No MeSH data available.


Immunostaining intensity (HSCORE) of NGAL (a) and L-FABP (b) in kidney cortex of all groups. *p < 0.05, ***p < 0.001 versus control group; +p < 0.05, +++p < 0.001 versus LPS group, ###p < 0.001 versus LPS + HES-RA group
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Fig3: Immunostaining intensity (HSCORE) of NGAL (a) and L-FABP (b) in kidney cortex of all groups. *p < 0.05, ***p < 0.001 versus control group; +p < 0.05, +++p < 0.001 versus LPS group, ###p < 0.001 versus LPS + HES-RA group

Mentions: Biomarkers of AKI (NGAL and L-FABP) were significantly increased in the kidney after LPS infusion (p < 0.05 and p < 0.001, respectively, versus the control group) (Fig. 3). The resuscitation fluid combined with NAC significantly decreased these biomarkers compared to the LPS alone group (p < 0.001 and <0.05, respectively). Moreover, L-FABP was lower in the group of septic rats resuscitated with HES-RA + NAC than with HES-RA alone (p < 0.001).Fig. 3


Effects of N -acetylcysteine (NAC) supplementation in resuscitation fluids on renal microcirculatory oxygenation, inflammation, and function in a rat model of endotoxemia
Immunostaining intensity (HSCORE) of NGAL (a) and L-FABP (b) in kidney cortex of all groups. *p < 0.05, ***p < 0.001 versus control group; +p < 0.05, +++p < 0.001 versus LPS group, ###p < 0.001 versus LPS + HES-RA group
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Related In: Results  -  Collection

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Fig3: Immunostaining intensity (HSCORE) of NGAL (a) and L-FABP (b) in kidney cortex of all groups. *p < 0.05, ***p < 0.001 versus control group; +p < 0.05, +++p < 0.001 versus LPS group, ###p < 0.001 versus LPS + HES-RA group
Mentions: Biomarkers of AKI (NGAL and L-FABP) were significantly increased in the kidney after LPS infusion (p < 0.05 and p < 0.001, respectively, versus the control group) (Fig. 3). The resuscitation fluid combined with NAC significantly decreased these biomarkers compared to the LPS alone group (p < 0.001 and <0.05, respectively). Moreover, L-FABP was lower in the group of septic rats resuscitated with HES-RA + NAC than with HES-RA alone (p < 0.001).Fig. 3

View Article: PubMed Central - PubMed

ABSTRACT

Background: Modulation of inflammation and oxidative stress appears to limit sepsis-induced damage in experimental models. The kidney is one of the most sensitive organs to injury during septic shock. In this study, we evaluated the effect of N-acetylcysteine (NAC) administration in conjunction with fluid resuscitation on renal oxygenation and function. We hypothesized that reducing inflammation would improve the microcirculatory oxygenation in the kidney and limit the onset of acute kidney injury (AKI).

Methods: Rats were randomized into five groups (n&thinsp;=&thinsp;8 per group): (1) control group, (2) control&thinsp;+&thinsp;NAC, (3) endotoxemic shock with lipopolysaccharide (LPS) without fluids, (4) LPS&thinsp;+&thinsp;fluid resuscitation, and (5) LPS&thinsp;+&thinsp;fluid resuscitation&thinsp;+&thinsp;NAC (150&nbsp;mg/kg/h). Fluid resuscitation was initiated at 120&nbsp;min and maintained at fixed volume for 2&nbsp;h with hydroxyethyl starch (HES 130/0.4) dissolved in acetate-balanced Ringer&rsquo;s solution (Volulyte) with or without supplementation with NAC (150&nbsp;mg/kg/h). Oxygen tension in the renal cortex (C&mu;PO2), outer medulla (M&mu;PO2), and renal vein was measured using phosphorimetry. Biomarkers of renal injury, inflammation, and oxidative stress were assessed in kidney tissues.

Results: Fluid resuscitation significantly improved the systemic and renal macrohemodynamic parameters after LPS. However, the addition of NAC further improved cortical renal oxygenation, oxygen delivery, and oxygen consumption (p&thinsp;&lt;&thinsp;0.05). NAC supplementation dampened the accumulation of NGAL or L-FABP, hyaluronic acid, and nitric oxide in kidney tissue (p&thinsp;&lt;&thinsp;0.01).

Conclusion: The addition of NAC to fluid resuscitation may improve renal oxygenation and attenuate microvascular dysfunction and AKI. Decreases in renal NO and hyaluronic acid levels may be involved in this beneficial effect. A therapeutic strategy combining initial fluid resuscitation with antioxidant therapies may prevent sepsis-induced AKI.

No MeSH data available.