Renal bioenergetics during early gram-negative mammalian sepsis and angiotensin II infusion

Abstract

During early hypotensive experimental gram-negative sepsis, there was no evidence of renal bioenergetic failure despite decreased RBF. In this setting, the addition of a powerful renal vasoconstrictor does not lead to deterioration in renal bioenergetics.

Sepsis-Associated Acute Kidney Injury: Macrohemodynamic and Microhemodynamic Alterations in the Renal Circulation

“…35 Finally, in severe experimental hypotensive sepsis in sheep in which, after an initial increase, RBF then decreased (presumably owing to profound systemic vasodilation and myocardial depression), renal adenosine triphosphate levels, as measured by magnetic resonance imaging spectroscopy, remained unchanged. 36 In fact, even in ischemia-reperfusion models, the role of ongoing renal ischemia in the progression of AKI is unclear. For instance, in a pig model of aortic cross-clamping, renal reperfusion RBF initially was restored and only then decreased progressively, despite normal systemic hemodynamics, 37 suggesting that intrarenal factors including endothelial injury, microvascular thrombosis, and inflammation were causing microcirculatory hypoperfusion and increasing renal vascular resistance.…”

Sepsis-induced acute kidney injury—is there a lack of energy?

“…In summary, this important study by May et al [14] suggests that septic AKI does not necessarily have to be associated with major renal energy depletion. Acute tubular necrosis develops from the aggregated effects of the many cellular reactions activated by a severe lack of usable energy.…”

“…In this issue of Intensive Care Medicine, May et al [14] present new interesting data on renal ATP production Intensive Care Med (2012) 38:735-737 DOI 10.1007/s00134-012-2489-0 in anesthetized sheep during sepsis induced by an infusion of live E. coli. Prior to the experiments the animals were surgically prepared with a transit-time flow-probe around the left renal artery to measure RBF and with a custommade phosphorus coil surrounding the left kidney.…”

“…The experiments by May et al [14] presented in the current issue are performed in a large-animal model using a validated technique for estimating ATP levels. Obviously, the sheep had to be anesthetized to facilitate placement in the MR-scanner and to prevent movement during the measurements.…”

Angiotensin II in Septic Shock

“…However, so far, most of our knowledge about the RAS system during septic shock has come from a few experimental studies performed with healthy rodents [17,[21][22][23][24][25][26], sheep [27,28] or pigs [7]. The role of exogenous angiotensin II administration or its inhibition in sepsis is poorly understood [29].…”