Opioids Preconditioning Upon Renal Function and Ischemia-Reperfusion Injury: A Narrative Review

Abstract

Kidneys have an important role in regulating water volume, blood pressure, secretion of hormones and acid-base and electrolyte balance. Kidney dysfunction derived from acute injury can, under certain conditions, progress to chronic kidney disease. In the late stages of kidney disease, treatment is limited to replacement therapy: Dialysis and transplantation. After renal transplant, grafts suffer from activation of immune cells and generation of oxidant molecules. Anesthetic preconditioning has emerged as a promising strategy to ameliorate ischemia reperfusion injury. This review compiles some significant aspects of renal physiology and discusses current understanding of the effects of anesthetic preconditioning upon renal function and ischemia reperfusion injury, focusing on opioids and its properties ameliorating renal injury. According to the available evidence, opioid preconditioning appears to reduce inflammation and reactive oxygen species generation after ischemia reperfusion. Therefore, opioid preconditioning represents a promising strategy to reduce renal ischemia reperfusion injury and, its application on current clinical practice could be beneficial in events such as acute renal injury and kidney transplantation.

N-Acetylaspartylglutamate (NAAG) Pretreatment Reduces Hypoxic-Ischemic Brain Damage and Oxidative Stress in Neonatal Rats

“…This phenomenon is induced by a variety of treatments that make neurons more resistant to a subsequent ischemic or hypoxic insult. The most commonly used treatment is the preconditioning with mild ischemia, although the neuroprotective effects of hypoxic, pharmacological, and hyperbaric oxygen preconditioning have also been demonstrated [ 70 , 71 , 72 , 73 ]. It has not been fully revealed how the preconditioned neurons adapt to subsequent ischemic insult, but many scientists agree that it involves multiple protective mechanisms.…”

Effects of dexmedetomidine on immune function, renal function and inflammatory factors of patients undergoing percutaneous nephrolithotomy under general anesthesia

“…Dexmedetomidine, an imidazole derivative, has a very high selective binding with α2 adrenergic receptor and acts as a α2 adrenergic agonist, with high efficiency and high selectivity. The binding products of dexmedetomidine not only inhibit the sympathetic nervous system, but also can reduce the release of norepinephrine, which helps provide protection to the kidneys ( 24 ). Ammar et al ( 25 ) demonstrated that dexmedetomidine has a protective effect on kidney function in cardiac surgery.…”

Sex Differences in Renal Function: Participation of Gonadal Hormones and Prolactin

“…The kidneys are responsible for eliminating waste products from the body, controlling blood pressure, and the homeostasis of hormones, water, and solutes [3]. This organ is made up of cortical and medullar zones, containing its functional units, the nephrons.…”