The precise mechanism of erythropoietin (ESF) production and release from the kidney still remains obscure although it is well known that many forms of hypoxia, e.g., anemic, hypoxic, ischemic, and histotoxic, are capable of increasing erythropoietin production by the kidney (1). Recent observations (2, 3) indicate that following renal artery constriction in the dog, there is a release of prostaglandins (PG) into the renal venous blood. We have reported recently (4-6) that both hypoxic and ischemic hypoxia are capable of producing a significant increase in prostaglandin E (PGE) release into the renal venous effluent, which was blocked by the potent prostaglandin synthetase inhibitor, indomethacin. We have also demonstrated (7, 8) that indomethacin is capable of blocking erythropoietin production as well.Thus, the present studies were carried out to assess the relationship between PGE release and erythropoietin production by the kidney during a 12-hr ischemic hypoxic stimulus induced by means of renal artery constriction as well as the effects of indomethacin on these changes.Materials and methods. Twelve female mongrel dogs (six control and six indomethacin-treated) weighing 14.5-21 kg were used in this study. The animals were anesthetized with sodium pentobarbital (30 mg/ kg iv), and the left femoral arteries were cannulated for monitoring systemic arterial blood pressure (Statham P23AC pressure transducer) and the collection of arterial blood samples for erythropoietin bioassay. The animals were subjected to retroperitoneal laparotomies permitting extirpation of the right kidney and the exposure of the left kidney through a flank incision. A branch of the left ovarian vein was isolated and a cannula was inserted through this vein into the left renal vein to collect renal venous blood samples for PGE assay. Utilizing a squarewave electromagnetic blood flowmeter (Carolina Medical Electronics, Model 501) and either an 8-or 10-mm circumference flow probe, renal blood flow (RBF) was monitored with the probe placed around the left renal artery. Systemic arterial blood pressure (BP) and RBF were recorded continuously throughout the experimental period on a Grass oscillographic recorder (Model 7PCPA).After the initial zero time parameters (BP, RBF) and blood samples for PGE and erythropoietin were collected, a vascular occluder (Model OC12, IN VIVO Metric Systems) was placed around the left renal artery between the flow probe and the kidney. Renal blood flow was reduced to 30% of normal and sustained throughout the 12-hr experimental period with minor adjustments as needed. Six of the 12 dogs in the experimental group were pretreated with indomethacin (5 mg/kg orally) 18 and 2 hr prior to the application of the vascular occluder. Anesthesia was maintained throughout the experiments by administration of sodium pentobarbital as required via a cannula in the femoral vein.Blood samples for erythropoietin and
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Ejection fraction of 30-40% is an indication for hyperbaric oxygenation therapy. The decision about the treatment is made by the physician based on his experience, general condition of the patient, frequency and severity of hypoxic episodes. If EF% is 30% or below, HBO is not recommended, because antioxidative defense mechanisms are exhausted under hyypoxia and the balance of the organism should not be changed. An increase in average EF% by 11% demonstrates that combined use of HBO and Erythropoietin gives good results.
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