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Title: Urinary Oxygenation as a Surrogate Measure of Medullary Oxygenation During Angiotensin II Therapy in Septic Acute Kidney Injury.
Austin Authors: Lankadeva, Yugeesh R;Kosaka, Junko;Evans, Roger G;Bellomo, Rinaldo ;May, Clive N
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
The Australian and New Zealand Intensive Care Research Centre, Melbourne, Victoria, Australia
Cardiovascular Disease Program, Bioscience Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
Issue Date: Jan-2018
Publication information: Critical Care Medicine 2018; 46(1): e41-e48
Abstract: Angiotensin II is an emerging therapy for septic acute kidney injury, but it is unknown if its vasoconstrictor action induces renal hypoxia. We therefore examined the effects of angiotensin II on intrarenal PO2 in ovine sepsis. We also assessed the validity of urinary PO2 as a surrogate measure of medullary PO2. Interventional study. Research Institute. Sixteen adult Merino ewes (n = 8/group). Sheep were instrumented with fiber-optic probes in the renal cortex, medulla, and within a bladder catheter to measure PO2. Conscious sheep were infused with Escherichia coli for 32 hours. At 24-30 hours, angiotensin II (0.5-33.0 ng/kg/min) or saline vehicle was infused. Septic acute kidney injury was characterized by hypotension and a 60% ± 6% decrease in creatinine clearance. During sepsis, medullary PO2 decreased from 36 ± 1 to 30 ± 3 mm Hg after 1 hour and to 20 ± 2 mm Hg after 24 hours; at these times, urinary PO2 was 42 ± 2, 34 ± 2, and 23 ± 2 mm Hg. Increases in urinary neutrophil gelatinase-associated lipocalin (12% ± 3%) and serum creatinine (60% ± 23%) were only detected at 8 and 24 hours, respectively. IV infusion of angiotensin II, at 24 hours of sepsis, restored arterial pressure and improved creatinine clearance, while not exacerbating medullary or urinary hypoxia. In septic acute kidney injury, renal medullary and urinary hypoxia developed several hours before increases in currently used biomarkers. Angiotensin II transiently improved renal function without worsening medullary hypoxia. In septic acute kidney injury, angiotensin II appears to be a safe, effective therapy, and urinary PO2 may be used to detect medullary hypoxia.
DOI: 10.1097/CCM.0000000000002797
ORCID: 0000-0002-1650-8939
Journal: Critical Care Medicine
PubMed URL: 29077618
Type: Journal Article
Appears in Collections:Journal articles

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