ABSTRACT
Postoperative decline of renal function remains a common and unpredictable complication after abdominal aortic aneurysm (AAA) reconstruction. The oxidative stress that occurs during perioperative ischemia/reperfusion injury (I/R) may contribute to the development of this complication. In this study, the influence of intraoperative prostaglandin E (alprostadil) administration on erythrocyte and platelet antioxidants as well as postoperative kidney function modulation were verified. AAA patients were randomly divided into control and study/alprostadil groups. Blood samples were collected directly before aortic clamping and 5 min after aortic declamping. Superoxide dismutase, catalase, glutathione, glutathione peroxidase (GPx), and glutathione transferase (GST) were measured using spectrophotometry. During I/R, the activity of catalase (57.14+/-30.65 vs 128.35+/-91.94 U/mg protein; P < 0.009), GPx (0.21+/-0.18 vs 0.35+/-0.21 mU/g protein; P = 0.028), and GST (217.49+/-101.39 vs 310.66+/-88.86 mU/g protein; P = 0.0006) significantly increased in the control group. GST activity before the aortic clamping was significantly lower in the study/alprostadil group (2.84+/-2.28 vs 3.48+/-2.30 U/g Hb; P = 0.05). The activity of the selected antioxidants proved to be of a diagnostic value for predicting postoperative decline in renal function. In conclusion, during I/R after AAA reconstruction, activation of various erythrocyte and platelet antioxidants occurs. Perioperative administration of alprostadil is associated with disruption of this activation.
Subject(s)
Alprostadil/administration & dosage , Aortic Aneurysm, Abdominal/surgery , Blood Platelets/metabolism , Erythrocytes/metabolism , Kidney Diseases/blood , Reperfusion Injury/blood , Vasodilator Agents/administration & dosage , Aged , Antioxidants/metabolism , Aortic Aneurysm, Abdominal/metabolism , Aortic Aneurysm, Abdominal/pathology , Humans , Kidney/blood supply , Kidney/metabolism , Kidney/pathology , Kidney Diseases/etiology , Kidney Diseases/pathology , Kidney Function Tests , Male , Middle Aged , Oxidation-Reduction , Oxidoreductases/blood , Reperfusion Injury/etiology , Reperfusion Injury/pathologyABSTRACT
Eicosanoids, active metabolites of arachidonic acid (AA), play an important role in the regulation of renal haemodynamics and glomerular filtration. Our study verified the hypothesis on the positive action of exogenously administered PGE(1) on renal function during an operation with temporary ischaemia of the lower half of the body. Also the effect of alprostadil (prostaglandin E(1) analogue) administered during the operation of an abdominal aorta aneurysm on the postoperative systemic metabolism of AA and the glomerular filtration rate (GFR) was investigated. The study included 42 patients with a diagnosed abdominal aorta aneurysm who have been qualified for the operation of implantation of the aortic prosthesis. The patients were randomly assigned to two groups: the study group (I) receiving alprostadil and the control group (II) without alprostadil. The levels of hydroxyeicosatetraenoic acids (15-HETE, 12-HETE, 5-HETE) were determined by RP-HPLC and the level of thromboxane B(2) (TxB(2)) was determined by ELISA in the plasma of the blood drawn from vena cava superior immediately before aortic clamping (A) and 5 min after aortic declamping (B). The administration of PGE(1) affects the metabolism of 15-HETE in a manner dependent on the baseline value of GFR but does not significantly change the postoperative renal function. The metabolism of 15-HETE is affected by the baseline value of GFR1 and a longer period of ischaemia is correlated with lower concentrations of 5-HETE during reperfusion. The results of our studies indicate that TxB(2) influences the postoperative function of kidneys.
Subject(s)
Alprostadil/administration & dosage , Glomerular Filtration Rate/drug effects , Hydroxyeicosatetraenoic Acids/metabolism , Kidney/drug effects , Reperfusion Injury/metabolism , 12-Hydroxy-5,8,10,14-eicosatetraenoic Acid/blood , 12-Hydroxy-5,8,10,14-eicosatetraenoic Acid/metabolism , Aged , Aortic Aneurysm/surgery , Eicosanoids/blood , Eicosanoids/metabolism , Female , Humans , Hydroxyeicosatetraenoic Acids/blood , Kidney/physiology , Male , Middle Aged , Postoperative Period , Thromboxane B2/blood , Thromboxane B2/metabolismABSTRACT
We present a case of a 40-year-old multigravida with rare combination of HELLP syndrome followed by hemorrhagic complications, DIC, acute renal failure, ARDS. During her stay in intensive care unit total abdominal hysterectomy was performed. Peritoneal dialysis was conducted for two days because of transient acute renal failure. A gradual improvement of her condition was observed after drainage of extraperitoneal haematoma. After forty-two days she was extubated and discharged from intensive care unit.
