Effect of selective inhibition of renal inducible nitric oxide synthase on renal blood flow and function in experimental hyperdynamic sepsis*

Ishikawa, Ken; Calzavacca, Paolo; Bellomo, Rinaldo; Bailey, Michael; May, Clive

doi:10.1097/ccm.0b013e3182514be9

Cited by 32 publications

(31 citation statements)

References 35 publications

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“…However, it is unlikely that the effect of TLR4 inhibition on renal function in this study is mediated by reduced NO formation as there were no differences in either MAP or renal blood flow and as TAK-242 did not affect NOx or cyclic guanosine monophosphate (cGMP) levels. This view is supported by results demonstrating no effect on renal function after intrarenal NO synthase inhibition during Gramnegative sepsis [33].…”

Section: Discussionsupporting

confidence: 76%

“…A recently promoted hypothesis for sepsis-induced AKI is that the inflammatory response causes a preferential dilatation of renal efferent arterioles, increasing renal blood flow but reducing the hydrostatic pressure for glomerular filtration and thereby glomerular filtration rate (GFR) [32]. The most important vasodilator released in sepsis is NO, and it has been suggested that excessive intra-renal NO could be responsible for the reduction in postglomerular resistance [33]. However, it is unlikely that the effect of TLR4 inhibition on renal function in this study is mediated by reduced NO formation as there were no differences in either MAP or renal blood flow and as TAK-242 did not affect NOx or cyclic guanosine monophosphate (cGMP) levels.…”

Section: Discussionmentioning

confidence: 99%

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Renal effects of treatment with a TLR4-inhibitor in conscious septic sheep

Fenhammar¹,

Rundgren²,

Hultenby³

et al. 2014

Crit Care

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Introduction: Acute kidney injury (AKI) is a common and feared complication of sepsis. The pathogenesis of sepsis-induced AKI is largely unknown, and therapeutic interventions are mainly supportive. In the present study, we tested the hypothesis that pharmacological inhibition of Toll-like receptor 4 (TLR4) would improve renal function and reduce renal damage in experimental sepsis, even after AKI had already developed. Methods: Sheep were surgically instrumented and subjected to a 36-hour intravenous infusion of live Escherichia coli. After 12 hours, they were randomized to treatment with a selective TLR4 inhibitor (TAK-242) or vehicle.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Renal effects of treatment with a TLR4-inhibitor in conscious septic sheep

Fenhammar¹,

Rundgren²,

Hultenby³

et al. 2014

Crit Care

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“…Indeed, some pathophysiological processes may be associated with increased global renal blood flow [9,10] despite loss of function. In such instances, there is experimental evidence that, at least in sepsis, this phenomenon may be caused by intra-renal shunting [11].…”

Section: Introductionmentioning

confidence: 99%

Measurement of kidney perfusion in critically ill Patients

2013

Self Cite

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“…Finally it should be noted that in the sepsis induced mitochondrial dysfunction there is an increased production of nitric oxide, secondary to the induced form of the type II nitric oxide synthase [becoming another therapeutic target], and inhibiting the Neural isoform [NOS] so far with arguable results [50,51].…”

Section: Treating the Hypoperfusionmentioning

confidence: 99%

Perfusion Measurement of the Septic Patient in the Emergency Department

Devia-Jaramillo¹

2014

Emergency Medicine

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Sepsis is a deadly disease, more complex and frequent every day, that requires management from different specialists. The emergency physician is the first and one of the most important physicians that has to deal with the septic critically ill patients, because an appropriate initial management is key to a favorable outcome.In the emergency department it can be hard to predict which patients will become sicker just with information from the vital signs, and it's even harder to predict which patients will require a more intensive medical treatment. That is the reason why there must be more resources to measure tissue perfusion in an early and simple way in the emergency room, so that the emergency physician can manage to establish which patients requires earlier intervention to improve their perfusion state, despite not showing any clinically evident signs that help in the diagnosis of their current state.The goal of this paper is to propose a diagnostic and therapeutic algorithm for the hypoperfused patient with septic shock in the emergency department.venous oxygen saturation, arterial and venous lactate, microcirculatory study in different anatomical sites and oxygenation indexes.The emergency department, a place of rapid transit, with time constraints, progressive overcrowding and limited physical space, requires efficient indicators of early appearance and simple implementation in the system. That is why this article aims to show a proposal of early detection of hypoperfusion in the septic patient in the emergency room.

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Effect of selective inhibition of renal inducible nitric oxide synthase on renal blood flow and function in experimental hyperdynamic sepsis*

Cited by 32 publications

References 35 publications

Renal effects of treatment with a TLR4-inhibitor in conscious septic sheep

Renal effects of treatment with a TLR4-inhibitor in conscious septic sheep

Measurement of kidney perfusion in critically ill Patients

Perfusion Measurement of the Septic Patient in the Emergency Department

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