Effects of crystalloid, hyper-oncotic albumin, and iso-oncotic albumin on lung and kidney damage in experimental acute lung injury

Abstract

Background Conflicting data have reported beneficial effects of crystalloids, hyper-oncotic albumin (20%ALB), and iso-oncotic albumin (5%ALB) in critically ill patients. Although hyper-oncotic albumin may minimize lung injury, recent studies have shown that human albumin may lead to kidney damage proportional to albumin concentration. In this context, we compared the effects of Ringer’s lactate (RL), 20%ALB, and 5%ALB, all titrated according to similar hemodynamic goals, on pulmonary function, lung and kidney histology, and molecular biology in experimental acute lung injury (ALI). Methods Male Wistar rats received Escherichia coli lipopolysaccharide intratracheally ( n = 24) to induce ALI. After 24 h, animals were anesthetized and randomly assigned to receive RL, 20%ALB, or 5%ALB ( n = 6/group) to maintain hemodynamic stability (distensibility index of inferior vena cava < 25%, mean arterial pressure > 65 mmHg). Rats were then mechanically ventilated for 6 h. Six animals, which received neither ventilation nor fluids (NV), were used for molecular biology analyses. Results The total fluid volume infused was higher in RL compared to 5%ALB and 20%ALB (median [interquartile range], 10.8[8.2–33.2] vs. 4.8[3.6–7.7] and 4.3[3.9–6.6] mL, respectively; p = 0.02 and p = 0.003). B-line counts on lung ultrasound ( p < 0.0001 and p = 0.0002) and serum lactate levels ( p = 0.01 and p = 0.01) were higher in RL than 5%ALB and 20%ALB. Diffuse alveolar damage score was lower in 5%ALB (10.5[8.5–12]) and 20%ALB (10.5[8.5–14]) than RL (16.5[12.5–20.5]) ( p < 0.05 and p = 0.03, respectively), while acute kidney injury score was lower in 5%ALB (9.5[6.5–10]) than 20%ALB (18[15–28.5], p = 0.0006) and RL (16 [15–19], p = 0.04). In lung tissue, mRNA expression of interleukin (IL)-6 was higher in RL (59.1[10.4–129.3]) than in 5%ALB (27.0[7.8–49.7], p = 0.04) or 20%ALB (3.7[7.8–49.7], p = 0.03), and IL-6 protein levels were higher in RL than 5%ALB and 20%ALB ( p = 0.026 and p = 0.021, respectively). In kidney tissue, mRNA expression and protein levels of kidney injury molecule (KIM)-1 were lower in 5%ALB than RL and 20%ALB, while nephronectin expression increased ( p = 0.01 and p = 0.01), respectively. Conclusions In a rat model of ALI, both iso-oncotic and hyper-oncotic albumin solutions were associated with less lung injury compared to Ringer’s lactate. However, hyper-oncotic albumin resulted in greater kidney damage than iso-oncotic albumin. This experimental study is a step towards f...

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“…Histological ndings were graded from 0 to 4 (0, no change; 1, changes affecting 25% of the eld of view; 2, changes affecting 25-50%; 3, changes affecting 51-75%, and 4, changes affecting >75% of the eld), according to the area affected by the features of interest (edema, tubular cell vacuolization, deranged brush border in proximal tubular epithelia, tubular cell death/desquamation, and in ammation). The nal kidney injury score in each rat was expressed as the sum of all values of all features obtained and ranged from 0 to 20 [18].…”

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