Ulus Travma Acil Cerrahi Derg. 2010; 16(2): 103-107

Karýn içi basýncýn hýzla artýþý sonrasý geliþen renal histopatolojik ve sitokin deðiþiklikleri: Bir hayvan çalýþmasý

Gökhan Akbulut¹, Mustafa Altýndiþ¹, Fatma Aktepe¹, Mustafa Serteser², Osman Nuri Dilek^3
1Afyon Kocatepe Üniversitesi Týp Fakültesi Genel Cerrahi, Mikrobiyoloji Ve Patoloji Ad
²Sakarya Üniversitesi Týp Fakültesi Genel Cerrahi Ad
³Acýbadem Üniversitesi Týp Fakültesi Biyokimya Ad

AMAÇ
Abdominal kompartman sendromu sonrasý geliþen akut böbrek yetersizliðinin renal venöz basýncýn artýþý ile iliþkili olduðu düþünülmektedir. Bu çalýþmada, deðiþik karýn içi basýnç deðerlerinde renal tübüler ve glomerüler hücrelerdeki histopatolojik deðiþiklikler ile plazma ve renal doku sitokin düzeylerindeki deðiþiklikler araþtýrýldý ve karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
On sekiz Spraque-Dawley cinsi sýçan rastgele üç gruba ayrýldý: Sham grubu, basýncýn 20 ve 30 mmHg düzeyinde 60 dakika tutulduðu grup 2 ve grup 3. Deneklerin, sol böbrekleri ve intrakardiyak kan örnekleri iþlem sonunda alýndý. Tümör nekroz faktör alfa (TNF-α) ve interlökin 6 (IL-6) düzeyleri hem renal dokuda hem de plazmada araþtýrýldý. Renal dokular, histopatolojik deðiþiklikler açýsýndan da deðerlendirildi.
BULGULAR
Sham grubu çalýþma gruplarý ile karþýlaþtýrýldýðýnda, renal doku ve plazma TNF-α, IL-6 düzeylerinin anlamlý olarak arttýðý saptandý (p<0,05). Renal doku deðiþiklikleri deðerlendirildiðinde, total histopatolojik skorlarýn arttýðý (p<0,05) tübüler deðiþikliklerin, glomerüler deðiþikliklerden daha belirgin olduðu saptandý.
SONUÇ
Sonuç olarak, karýn içi basýnç artýþý, doðrusal olarak renal tübüler histopatolojik deðiþiklikleri arttýrmaktadýr. Sitokinler abdominal kompartman sendromunda geliþen akut böbrek yetersizliðinde rol oynuyor olabilirler.

Anahtar Kelimeler: Akut böbrek yetersizliði, sitokin; histopatoloji; karýn içi basýnç; oligüri; travma.

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Renal cytokine and histopathologic changes following acutely increased intra-abdominal pressure: an animal study

Gökhan Akbulut¹, Mustafa Altýndiþ¹, Fatma Aktepe¹, Mustafa Serteser², Osman Nuri Dilek^3
1Dept.’s Of General Surgery, Microbiology And Pathology Afyon Kocatepe University Faculty Of Medicine, Afyonkarahisar
²Dept. Of General Surgery, Sakarya University Faculty Of Medicine, Sakarya, Turkey.
³Dept. Of Biochemistry, Acýbadem University Faculty Of Medicine, Istanbul

BACKGROUND
The reason for acute renal failure (ARF) in abdominal compartment syndrome (ACS) is thought to be due to the increase in renal venous pressure. In this study, the changes in plasma and renal tissue cytokine levels and histopathologic changes in renal tubular and glomerular cells were evaluated and compared in a model of acute elevation in abdominal tension with different pressures.
METHODS
Eighteen Sprague-Dawley rats were randomly assigned into three groups: Sham-operated rats and rats in Groups 1 and 2, in which 20 and 30 mmHg of intra-abdominal pressure (IAP) was applied for 60 minutes, respectively. Left kidneys of the animals and intracardiac blood samples were taken at the end of the procedures. Tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels were investigated in plasma and renal tissue samples. Renal tissues were also evaluated for histopathologic changes.
RESULTS
Renal tissue and plasma TNF-α and IL-6 levels were found to be significantly increased when the sham-operated group was compared to the study groups (p<0.05). Renal tissue changes showed that the total histopathologic scores were significantly increased in study groups compared to the sham-operated group (p<0.05); tubular changes were more prominent than glomerular changes.
CONCLUSION
Abdominal tension linearly can cause renal tubular histopathologic changes. Cytokines may play a role in ARF due to ACS.

Keywords: Acute renal failure, cytokine; histopathology; intra-abdominal pressure; oliguria; trauma.

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