Atilla ARAL, Mustafa Bahadır İNAN, Ahmet RÜÇHAN AKAR, Aslıhan AVCI, Saba KİREMİTÇİ, Bilge Ayça KIRMIZI KARABÖRK, Demir ÇETİNTAŞ, Mustafa ŞIRLAK

Suprarenal kros klempe bağlı oluşan renal hasarın iskemik önkoşullanma ve karnitin ile önlenmesi: Deneysel çalışma

Amaç: Bu çalışmada, abdominal aort cerrahisi sırasında, suprarenal arterlere klemp konulmasının böbrek üzerindeki olumsuz etkileri ve önleme stratejileri araştırıldı.Ça lış ma pla nı: Wistar sıçanların aortuna suprarenal bölgede klemp konularak, abdominal aortik cerrahiyi taklit eder şekilde, renal iskemi modeli oluşturuldu. İki siklus uygulanan ve 10 dk. iskemi, 10 dk. reperfüzyon şeklindeki iskemik önkoşullanma, karnitin ve iskemik önkoşullanma + karnitin protokolü uygulandı. Nefrektomi materyalleri ve serum örneklerinde histopatolojik ve biyokimyasal değişiklikler incelendi.Bul gu lar: İskemi-reperfüzyon hasarından histopatolojik olarak ve istatistiksel yönden etkilenen bölgenin renal tübüller olduğu tespit edildi. İki siklus şeklinde 10 dk. iskemi ve 10 dk. reperfüzyon uygulamalı iskemik önkoşullanma işleminin iskemi-reperfüzyon hasarının önlenmesinde şüpheli olduğu bulundu. Oral karnitinin renal iskemi-reperfüzyon hasarını histopatolojik olarak azaltmadığı, ancak serbest oksijen radikallerine karşı önemli bir savunma olan katalaz enzim aktivitesini dokuda belirgin biçimde artırdığı saptandı.So nuç: İskemi önkoşullanma ve karnitin, suprarenal kros-klemp gerektiren abdominal aort cerrahisi sırasında oluşabilecek renal iskemi-reperfüzyon hasarını belli oranlarda engelleyebilir

Prevention of renal injury due to suprarenal cross-clamping with ischemic preconditioning and carnitine: an experimental study

Background: In this study, we investigated adverse effects of the clamping of suprarenal arteries on the kidney and prevention strategies during abdominal aortic surgery.Methods: A renal ischemia model was created by clamping the aorta of the suprarenal region of the Wistar rats, as mimicking abdominal aortic surgery. Two cycles of ischemic preconditioning with ischemia for 10 min and reperfusion for 10 min, carnitine and ischemic preconditioning + carnitine protocols were applied. Nephrectomy materials and histopathological and biochemical changes of serum samples were examined.Results: Renal tubules were the histopathologically and significantly affected regions by ischemia-reperfusion injury. It was found that the ischemic preconditioning procedure consisting of two cycles of ischemia for 10 min and reperfusion for 10 min was suspicious at preventing the reperfusion injury. Oral carnitine was unable to reduce the renal ischemia-reperfusion injury histopathologically; however, it significantly increased the tissue catalase activity.Conclusion: Ischemic preconditioning and carnitine may prevent renal ischemia-reperfusion injury to a certain extent during abdominal aortic surgery requiring suprarenal cross-clamping.

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Zimmerman BJ, Granger DN. Mechanisms of reperfusion injury. Am J Med Sci 1994;307:284-92.
Sasaki T, Ohsawa S, Ogawa M, Mukaida M, Nakajima T, Komoda K, et al. Postoperative renal function after an abdominal aortic aneurysm repair requiring a suprarenal aortic cross-clamp. Surg Today 2000;30:33-6.
Ockert S, Schumacher H, Böckler D, Malcherek K, Hansmann J, Allenberg J. Comparative early and midterm results of open juxtarenal and infrarenal aneurysm repair. Langenbecks Arch Surg 2007;392:725-30.
Chiesa R, Marone EM, Brioschi C, Frigerio S, Tshomba Y, Melissano G. Open repair of pararenal aortic aneurysms: operative management, early results, and risk factor analysis. Ann Vasc Surg 2006;20:739-46.
West CA, Noel AA, Bower TC, Cherry KJ Jr, Gloviczki P, Sullivan TM, et al. Factors affecting outcomes of open surgical repair of pararenal aortic aneurysms: a 10-year experience. J Vasc Surg 2006;43:921-7.
Kudo FA, Nishibe T, Miyazaki K, Murashita T, Yasuda K, Ando M, et al. Postoperative renal function after elective abdominal aortic aneurysm repair requiring suprarenal aortic cross-clamping. Surg Today 2004;34:1010-3.
Coselli JS. The use of left heart bypass in the repair of thoracoabdominal aortic aneurysms: current techniques and results. Semin Thorac Cardiovasc Surg 2003;15:326-32.
Köksoy C, LeMaire SA, Curling PE, Raskin SA, Schmittling ZC, Conklin LD, et al. Renal perfusion during thoracoabdominal aortic operations: cold crystalloid is superior to normothermic blood. Ann Thorac Surg 2002;73:730-8.
Safi HJ, Miller CC, Huynh TT, Estrera AL, Porat EE, Winnerkvist AN, et al. Distal aortic perfusion and cerebrospinal fluid drainage for thoracoabdominal and descending thoracic aortic repair: ten years of organ protection. Ann Surg 2003;238:372-80.
Svensson LG, Coselli JS, Safi HJ, Hess KR, Crawford ES. Appraisal of adjuncts to prevent acute renal failure after surgery on the thoracic or thoracoabdominal aorta. J Vasc Surg 1989;10:230-9.
Rhoden EL, Rhoden CR, Lucas ML, Pereira-Lima L, Zettler C, Belló-Klein A. The role of nitric oxide pathway in the renal ischemia-reperfusion injury in rats. Transpl Immunol 2002;10:277-84.
Ateş E, Genç E, Erkasap N, Erkasap S, Akman S, Firat P, et al. Renal protection by brief liver ischemia in rats. Transplantation 2002;74:1247-51.
Rasoulian B, Mohammadhosseniakbari H, Kadkhodaee M, Mofid M, Baqeri G, Bigdeli MR, et al. Preconditioning with oxygen attenuates rat renal ischemia-reperfusion injury. J Surg Res 2008;146:282-8.
Giulini SM, Bonardelli S, Portolani N, Giovanetti M, Galvani G, Maffeis R, et al. Suprarenal aortic cross-clamping in elective abdominal aortic aneurysm surgery. Eur J Vasc Endovasc Surg 2000;20:286-9.
Wahlberg E, Dimuzio PJ, Stoney RJ. Aortic clamping during elective operations for infrarenal disease: The influence of clamping time on renal function. J Vasc Surg 2002;36:13-8.
İşlekel H, İşlekel S, Güner G. Biochemical mechanism and tissue injury of cerebral ischemia and reperfusion. Available from: http://med.ege.edu.tr/ñorolbil/2000/NBD09200.html.
Gutteridge JM. Lipid peroxidation and antioxidants as biomarkers of tissue damage. Clin Chem 1995;41:1819-28.
Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 1986;74:1124-36.
Ulus AT, Yavas S, Sapmaz A, Sakaoğullari Z, Simsek E, Ersoz S, et al. Effect of conditioning on visceral organs during indirect ischemia/reperfusion injury. Ann Vasc Surg 2014;28:437-44.
Riera M, Herrero I, Torras J, Cruzado JM, Fatjo M, Lloberas N, et al. Ischemic preconditioning improves postischemic acute renal failure. Transplant Proc 1999;31:2346-7.
Turman MA, Bates CM. Susceptibility of human proximal tubular cells to hypoxia: effect of hypoxic preconditioning and comparison to glomerular cells. Ren Fail 1997;19:47-60.
Bremer J. Carnitine--metabolism and functions. Physiol Rev 1983;63:1420-80.
Berkan Ö, Yıldız E, Güneç F, Katrancıoğlu N, Günay İ, Doğan K. The effect of pentoxifylline, carnitine and ascorbid acid on improvement of lung injury caused by ischemia- reperfusion. Turk Gogus Kalp Dama 2002;10:92-5.
Bellinghieri G, Savica V, Mallamace A, Di Stefano C, Consolo F, Spagnoli LG, et al. Correlation between increased serum and tissue L-carnitine levels and improved muscle symptoms in hemodialyzed patients. Am J Clin Nutr 1983;38:523-31.
Ahmad S, Robertson HT, Golper TA, Wolfson M, Kurtin P, Katz LA, et al. Multicenter trial of L-carnitine in maintenance hemodialysis patients. II. Clinical and biochemical effects. Kidney Int 1990;38:912-8.
Suzuki Y, Narita M, Yamazaki N. Effects of L-carnitine on arrhythmias during hemodialysis. Jpn Heart J 1982;23:349-59.