Submitted on July 30, 2007
Accepted on January 29, 2008
Effects of acid aspiration-induced acute lung injury on kidney function
Jeffrey B. Hoag1, Manchang Liu1, R. Blaine Easley2, Martin F. Britos-Bray1, Priya Kesari1, Heitham Hassoun3, Mark Haas4, Rubin M. Tuder5, Hamid Rabb1, and Brett A Simon6*
1 Medicine, Johns Hopkins University, Baltimore, Maryland, United States
2 Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
3 Surgery, Johns Hopkins University, Baltimore, Maryland, United States
4 Pathology, Johns Hopkins University, Baltimore, Maryland, United States
5 Pulmonary and Critical Care medicine, University of Colorado at Denver, Health Sciences Center, 4200 East Ninth Ave, BRB 651, Box C272, Denver, Colorado, 80262, United States; Pathology, Johns Hopkins University, Baltimore, Maryland, United States; , United States
6 Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States; Medicine, Johns Hopkins University, Baltimore, Maryland, United States
* To whom correspondence should be addressed. E-mail: bsimon{at}jhmi.edu.
Acute Lung Injury (ALI) in combination with acute kidney injury (AKI) carries a mortality approaching 80% in the intensive care unit. Recently, attention has focused on the interaction of the lung and kidney in the setting of ALI and mechanical ventilation (MV). Small animal models of ALI and MV have demonstrated changes in inflammatory mediators, water channels, apoptosis and function in the kidney early in course of injury. The purpose of this investigation was to test the hypothesis that ALI and injurious MV cause early, measurable changes in kidney structure and function in a canine HCl-aspiration model of ALI when hemodynamics and arterial blood gas tensions are carefully controlled. Intratracheal HCL induced profound ALI as demonstrated by increased shunt fraction and airway pressures compared to sham injury. Sham injured animals had similar mean arterial pressure and arterial pCO2and HCO3 levels compared with injured animals. Measurements of renal function including renal blood flow, urine flow, serum creatinine, glomerular filtration rate, urine albumin to creatinine ratio, and kidney histology scores were not different between groups. With maintenance of hemodynamic parameters and alveolar ventilation, acute lung injury and injurious mechanical ventilation do not alter kidney structure and function early in the course of injury in this acid-aspiration canine model. Kidney injury in large animal models may be more similar to humans and may differ from results seen in small animal models.
