The influence of levosimendan and iloprost on renal ischemia-reperfusion: an experimental study

Abstract

The effects of iloprost on ischemia-reperfusion injury have been studied on the skeletal, muscle, liver, myocardium, kidney, and spinal cord. However, no sufficient data exist about effects of levosimendan on renal ischemia-reperfusion injury. The purpose of this experimental study was to investigate and compare effectiveness of levosimendan and iloprost on renal injury induced by ischemia and reperfusion. Fifty rabbits were divided into five groups. Levosimendan was continuously infused starting half an hour before the cross-clamp. Cross-clamp time was one hour. After one hour ischemia, levosimendan was continued for 4 h in Group A whereas Group B took iloprost in the same protocol. Group C was the control group which did not receive any medication. Group D was sham group and Group E was medicated both iloprost and levosimendan. Renal tissues were histologically and biochemically evaluated. The histological scores were obtained according to presence of tubular necrosis and atrophy, regenerative atypia, hydropic degeneration (Group A vs. Group C<0.001, Group B vs. Group C<0.001, Group D vs. Group C<0.01, Group E vs. Group C<0.001). Mean malondialdehyde levels were 114+/-12 nmol/g tissue; in Group A 121+/-13 nmol/g tissue, in Group B 134+/-13 nmol/g tissue, in Group E 130+/-11 nmol/g tissue, in Group D 134+/-11 nmol/g tissue (Group A vs. Group B; P=0.003, Group B vs. Group D; P=0.132, Group A vs. Group E; P=0.132). Malondialdehyde levels and histologic scores of all of the groups were significantly different from the control group. Iloprost and pentoxyfillin reduced renal ischemia-reperfusion injury in rabbit model. There was no significant difference between these two medications.

Efeito do levosimendan em pacientes com insuficiência cardíaca sistólica severa e agravamento da função renal

“…Although, the findings of our study were in accordance with the recent literature [21][22][23][24] , the small sample size and the lack of a comparable inotrope, which could have potentially increased the confounders, prevented us from drawing definitive conclusions. However, we performed a post hoc power analyses baseline and after the infusion creatinine levels in patients with and without worsening renal function.…”

Levosimendan Protection against Kidney Ischemia/Reperfusion Injuries in Anesthetized Pigs

“…For instance, in a clinical series of patients with cardiogenic shock who have been treated with levosimendan a significant reduction of polyuric syndrome after a stable hemodynamic recovery has been achieved (Caimmi et al, 2011a). Moreover, experimental evidence has shown tubular protection exerted by levosimendan against ischemic injuries (Yakut et al, 2008). Hence, levosimendan, in addition to improving myocardial contraction and exerting vasodilation, has been demonstrated to have the potential to protect against I/R damage through a preconditioning-like effect (Kersten et al, 2000;Soeding et al, 2011) and the reduction of inflammatory and oxidative stress profiles (Avgeropoulou et al, 2005).…”

The histopathological effects of levosimendan on liver injury induced by myocardial ischemia and reperfusion

“…It has been suggested that levosimendan also attenuates I/R injury in the spinal cord, lung, and in the renal tissue (15)(16)(17).…”