scholarly journals Delayed Remote Ischemic Preconditioning ConfersRenoprotection against Septic Acute Kidney Injury via Exosomal miR-21

Theranostics ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. 405-423 ◽  
Author(s):  
Tianyi Pan ◽  
Ping Jia ◽  
Nan Chen ◽  
Yi Fang ◽  
Yiran Liang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Preconditioning ◽  
Kidney Injury ◽  
Remote Ischemic Preconditioning ◽  
Septic Acute Kidney Injury

scholarly journals Remote Ischemic Preconditioning Protects Cisplatin-Induced Acute Kidney Injury through the PTEN/AKT Signaling Pathway

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Wanfen Zhang ◽  
Cheng Chen ◽  
Ran Jing ◽  
Tongqiang Liu ◽  
Bicheng Liu
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Preconditioning ◽  
Therapeutic Strategy ◽  
Molecular Mechanisms ◽  
Kidney Injury ◽  
Akt Signaling ◽  
Remote Ischemic Preconditioning ◽  
Pten Mrna ◽  
Induce Resistance ◽  
In Cis

Although cisplatin (Cis) is an effective chemotherapeutic agent in treatment of various cancers, its adverse effect of nephrotoxicity limits the clinical application. Remote ischemic preconditioning (RIPC) is a strategy to induce resistance in a target organ against the oxidative stress and injury by applying transient, brief episodes of ischemia. However, whether RIPC exerts protective effect on Cis-induced renal injury remains unclear. In this study, we showed that RIPC significantly alleviated the renal functional and histopathological damage of Cis-induced acute kidney injury (AKI) mice. Furthermore, RIPC substantially reversed the downregulation of miR-144 and upregulation of PTEN in renal tissues of Cis-induced AKI mice and alleviated tubular cell apoptosis via activating PTEN/AKT signaling. In mechanism, we demonstrated that miR-144 directly targets the 3’-UTR of PTEN mRNA, and then the elevation of miR-144 in RIPC activates PTEN/AKT signaling by downregulating PTEN expression to achieve its antiapoptosis effect. Collectively, our results indicate that RIPC may be a potential therapeutic strategy in Cis-induced AKI, and provide insights on the underlying molecular mechanisms of cisplatin’s nephrotoxicity.

Long-term Effects of Remote Ischemic Preconditioning on Kidney Function in High-risk Cardiac Surgery Patients

2017 ◽  
Vol 126 (5) ◽  
pp. 787-798 ◽  
Author(s):  
Alexander Zarbock ◽  
John A. Kellum ◽  
Hugo Van Aken ◽  
Christoph Schmidt ◽  
Mira Küllmar ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
High Risk ◽  
Renal Dysfunction ◽  
Ischemic Preconditioning ◽  
Absolute Risk ◽  
Kidney Injury ◽  
Absolute Risk Reduction ◽  
Remote Ischemic Preconditioning ◽  
Major Adverse Kidney Events

Abstract Background In a multicenter, randomized trial, the authors enrolled patients at high-risk for acute kidney injury as identified by a Cleveland Clinic Foundation score of 6 or more. The authors enrolled 240 patients at four hospitals and randomized them to remote ischemic preconditioning or control. The authors found that remote ischemic preconditioning reduced acute kidney injury in high-risk patients undergoing cardiac surgery. The authors now report on the effects of remote ischemic preconditioning on 90-day outcomes. Methods In this follow-up study of the RenalRIP trial, the authors examined the effect of remote ischemic preconditioning on the composite endpoint major adverse kidney events consisting of mortality, need for renal replacement therapy, and persistent renal dysfunction at 90 days. Secondary outcomes were persistent renal dysfunction and dialysis dependence in patients with acute kidney injury. Results Remote ischemic preconditioning significantly reduced the occurrence of major adverse kidney events at 90 days (17 of 120 [14.2%]) versus control (30 of 120 [25.0%]; absolute risk reduction, 10.8%; 95% CI, 0.9 to 20.8%; P = 0.034). In those patients who developed acute kidney injury after cardiac surgery, 2 of 38 subjects in the remote ischemic preconditioning group (5.3%) and 13 of 56 subjects in the control group (23.2%) failed to recover renal function at 90 days (absolute risk reduction, 17.9%; 95% CI, 4.8 to 31.1%; P = 0.020). Acute kidney injury biomarkers were also increased in patients reaching the major adverse kidney event endpoint compared to patients who did not. Conclusions Remote ischemic preconditioning significantly reduced the 3-month incidence of a composite endpoint major adverse kidney events consisting of mortality, need for renal replacement therapy, and persistent renal dysfunction in high-risk patients undergoing cardiac surgery. Furthermore, remote ischemic preconditioning enhanced renal recovery in patients with acute kidney injury.

scholarly journals The efficiency of remote ischemic preconditioning on serum cystatin C-based acute kidney injury in patients undergoing coronary angiography; a randomized controlled trial

2020 ◽  
Vol 10 (1) ◽  
pp. e09-e09
Author(s):  
Azadeh Moradkhani ◽  
Hamid Reza Samimagham ◽  
Mohammad Tamaddondar ◽  
Hossein Farshidi ◽  
Mahmood Khayatian ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Cystatin C ◽  
Ischemic Preconditioning ◽  
Controlled Trial ◽  
Kidney Injury ◽  
Remote Ischemic Preconditioning ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Significant Difference

Introduction: Contrast-induced acute kidney injury (CI-AKI) is a known complication of cardiac interventions. Remote ischemic preconditioning (RIPC) is a non-pharmacological method which has a nephroprotective effect. Serum cystatin C (CysC) is a suitable biomarker for the early diagnosis of AKI. Objectives: This study aimed to evaluate the incidence of CI-AKI after RIPC in patients undergoing coronary angiography, through assessment of CysC. Patients and Methods: Around 140 patients with stable coronary artery disease undergoing angiography were randomly allocated to two groups of RIPC and control groups. In each group, the following biomarkers were assessed: serum creatinine (Cr) and CysC at baseline, 24-hour and 48-hour serum Cr and 24-hour CysC. The endpoint was the development of AKI based on either the KDIGO criteria or a 15% increase in serum CysC. Results: No significant difference was observed between two groups regarding the incidence of AKI according to either KIDIGO criteria or by the increase of serum CysC (P =0.116 and P =0.392, respectively). Moreover, a 46.99% increase in CysC level was observed among patients with AKI during the first 24 hours after the procedure, while at the same interval, it increased only 16.01% in patients without AKI. Conclusion: RIPC with three cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease serum CysC based CI-AKI or alter renal biomarkers course in patients with low risk, who underwent coronary angiography.

scholarly journals Pengaruh Remote Ischemic Preconditioning Terhadap Angka Kejadian Aritmia dan Acute Kidney Injury Pada Pasien Dewasa Pasca Operasi Bedah Jantung

2016 ◽  
Vol 8 (2) ◽  
pp. 122
Author(s):  
Dedy Fachrian ◽  
Mohamad Sofyan Harahap
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Preconditioning ◽  
Kidney Injury ◽  
Drop Out ◽  
Remote Ischemic Preconditioning

Latar Belakang : Cedera reperfusi (IRI) akibat klem aorta saat operasi jantung mengakibatkan kematian kardiomiosit, gangguan fungsi kontraktilitas jantung, aritmia, dan kematian. Penggunaan CPB juga memicu terjadinya acute kidney injury (AKI) yang prevalensinya mencapai 30%. Salah satu pencegahannya adalah mempersiapkan miokardium terhadap efek buruk dari klem aorta. Mempersiapkan (preconditioning) miokardium ini pada dasarnya adalah untuk meningkatkan stimulasi dari mekanisme kardioprotektif bawaan melalui tindakan pemberian iskemia yang tidak mematikan secara periodik. Pemberian iskemik pada otot rangka lengan atau tungkai dengan menggunakan manset bertekanan secara periodik dan durasi yang singkat dapat memberikan proteksi pada miokardium dan ginjal dari IRI. Hal ini diharapkan dapat mencegah aritmia dan AKI setelah operasi jantung.Tujuan : Mengetahui apakah RIPC dapat mencegah aritmia dan Acute Kidney Injury (AKI) pada pasien setelah operasi bedah jantung dengan klem aorta dan menggunaan mesin CPB.Metode : Penelitian ini merupakan jenis uji klinis acak terkontrol. Sampel sebanyak 30 pasien yeng terbagi menjadi 2 kelompok yaitu kelompok kontrol (K) 15 subjek dan perlakuan (P) 15 subjek. Kelompok perlakuan setelah dilakukan induksi anestesi dan sebelum dilakukan sternotomi akan diberikan prosedur RIPC yaitu dengan melakukan pengembangan manset pada salah satu lengan atas sampai 200 mmHg dan dipertahankan selama 5 menit kemudian manset di kempiskan dan hal ini dipertahankan sampai 5 menit. Siklus ini kemudian diulangi lagi sehingga lama prosedur ini memakan waktu selama 20 menit. Sedangkan pada kelompok kontrol manset dipasang pada salah satu lengan atas subjek dan dibiarkan tidak dikembangkan selama 20 menit. Selama operasi lama tindakan ligasi aorta diukur dan jika lama ligasi aorta lebih dari 20 menit maka penelitian dilanjutkan tetapi jika lama ligasi aorta kurang dari 20 menit maka subjek penelitian di drop out dari penelitian. Setelah dilakukan pembukaan ligasi aorta, pemantauan akan adanya aritmia dimulai sampai 24 jam kedepan. Setelah operasi selesai dan pasien di transfer ke ICU, pada perawatan jam ke 12, 24, 36, 48, 60 dan 72 jam perawatan dilakukan pemantauan produksi urine dan pengambilan sampel darah dan diperiksa kadar serum kreatinin.Hasil : Aritmia didapatkan pada 11 subjek kontrol dan 2 subjek perlakuan dengan Atrial Fibrilasi merupakan jenis aritmia yang paling banyak didapatkan yaitu 9 subjek pada kontrol dan 1 subjek pada perlakuan. AKI didapatkan pada 11 subjek kontrol dan 1 subjek perlakuan. Pada uji Mann-Whitney didapatkan penurunan angka kejadian aritmia pada kelompok perlakuan yang berbeda bermakna (p=0,01) serta penurunan angka kejadian AKI pada kelompok perlakuan yang berbeda bermakna (p=0,04).Kesimpulan : Tindakan RIPC dengan 2 siklus iskemia dan reperfusi pada kelompok perlakuan terbukti menurunkan angka kejadian aritmia dan AKI pasca operasi jantung secara bermakna dibanding kelompok kontrol.

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