Nifedipine improves recovery function of kidneys preserved in a high- sodium, low-potassium cold-storage solution: study with the isolated perfused rat kidney technique

Autor: S.G. Ramella-Virieux, Zech P, A. Barbieux, Aoumeur Hadj-Aissa, Nicole Pozet, Jean-Paul Steghens
Rok vydání: 1997
Předmět:
Zdroj: Nephrology Dialysis Transplantation. 12:449-455
ISSN: 1460-2385
0931-0509
Popis: erular filtration rate; isolated perfused kidney; sodium reabsorption Background. Extracellular types (high-Na) of coldstorage solution (CSS ) have been shown to be more effective in preserving kidneys than intracellular CSS ( high-K). On the other hand, calcium entry blockers (CEB) have been demonstrated to improve graft Introduction function when administered after and/or prior to transplantation. The ischaemia reperfusion syndrome Numerous factors are involved in the process of acute involves, in part, an alteration in intracellular calcium renal failure of the ischaemia reperfusion syndrome metabolism that induces an increase in renal vascular [1]: the duration of warm and cold ischaemia, the resistances (RVR) and other cellular dysfunction, and efficiency of the cold-storage solutions, and the normohigh-K CSS per se are vasoconstrictive. Since CEB act thermic reperfusion per se. At each step, alterations in via a modification in intracellular calcium metabolism cellular calcium homeostasis appears to be of major on vascular smooth muscle, glomerular, and tubular significance [2]. During the past decade, a number of cells, we evaluated the actual benefit on CEB on clinical investigations have been undertaken to study kidneys preserved in Belzer’s CSS ( K-UW ) and a enhancement of hypothermic protection with the addihigh-Na version of Belzer’s CSS (Na-UW ). tion of calcium entry blockers (CEB). Several studies Method. The isolated perfused rat kidney ( IPK) was showed that the administration of CEB seems to reduce used, first as a vascular bed to test the effects of CSS the incidence of delayed graft function, prevents acute on RVR, and the influence of nifedipine. Second, the cyclosporin toxicity and lessens the number of rejection recovery function of the IPK was assessed by GFR episodes in the first few weeks after transplantation and tubular Na reabsorption, after 24 h preservation [3,4]. Recent studies [5,6 ] suggest that the short-term in K-UW and Na-UW, with or without nifedipine. improvements noted in both graft function and Results were compared with a control group in which rejection episodes with CEB are maintained for the renal function was measured without prior cold- first year post-transplantation and furthermore, the storage. use of CEB results in improved 1 year graft survival. Results. K-UW but not Na-UW induced an increase However, as usually in clinical studies, some drawbacks in RVR when flushed into the kidney. This vasocon- may raise uncertainty about results, such as cyclospostriction is prevented by nifedipine. K-UW CSS was rin-associated treatment and dosage that may vary more deleterious to renal function than Na-UW. during the follow-up, the possibility that the different Addition of nifedipine to the flush, the CSS for 24 h, CEB may act differently on the metabolism of cycloand to the normothermic reperfusate further improved sporin, and the lack of standardization of CEB dosing recovery function of the IPK cold stored in Na-UW that has to be adapted to blood pressure. but not in K-UW, without any modification of RVR. In several experimental models of ischaemic acute Conclusion. Nifedipine may be of potential effect in renal failure, CEB have been reported to be of value attenuating ischaemic injury by a mechanism which in preserving organ function but have not been extensdoes not involve its vasodilatory properties. ively studied with respect to renal preservation [7 ]. Despite some disadvantages and limitations the isol
Databáze: OpenAIRE
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