The Degree of Aortic Occlusion in the Setting of Trauma Alters the Extent of Acute Kidney Injury Associated with Mitochondrial Preservation

Am J Physiol Renal Physiol. 2024 Mar 7. doi: 10.1152/ajprenal.00323.2023. Online ahead of print.ABSTRACTResuscitative endovascular balloon occlusion of the aorta (REBOA) is used to control non-compressible hemorrhage not addressed with traditional tourniquets. However, REBOA is associated with acute kidney injury (AKI) and subsequent mortality in severe trauma patients. Herein, we investigated how the degree of aortic occlusion alters AKI in a porcine model. Female Yorkshire-cross swine (n=16, 68.1±0.7Kg) were anesthetized, and had carotid and bilateral femoral arteries accessed for REBOA insertion and distal and proximal blood pressure monitoring. Through a laparotomy, a 6cm liver laceration was performed and balloon inflation was performed in Zone 1 of the aorta for 90 minutes during which animals were randomized to target distal MAPs of 25 or 45mmHg via balloon volume adjustment. Blood draws were taken at baseline, end of occlusion, and time of death, at which point renal tissues were harvested 6 hours post balloon deflation for histological and molecular analyses. Renal blood flow was lower in the 25mmHg group (48.5±18.3mL) than the 45mmHg group (177.9±27.2 mL/min) during the occlusion phase, which recovered and was not different post balloon deflation. AKI was more severe in the 25mmHg group as evidenced by circulating creatinine, blood urea nitrogen, and urinary neutrophil gelatinase associated lipocalin (NGAL). The 25mmHg group had increased tubular necrosis, lower ...
Source: American Journal of Physiology. Renal Physiology - Category: Physiology Authors: Source Type: research