[en] The kidney is faced to an impairment of oxygen extraction during sepsis which is well-known to be a risk factor for the development of acute kidney injury (AKI). Recent research activities in the mechanisms involved in the development of AKI in sepsis emphasize the central role of hemodynamic and inflammatory events. More particularly, two mechanisms are suggested to explain the inability of the injured kidney to extract oxygen: tissue hypoxia and cellular energetic metabolism dysfunction. Our working hypothesis of the pathophysiology of AKI is based on cellular respiratory dysfunction due to the inflammatory response inherent to sepsis.
To study the mechanism of oxygen regulation in inflammation-induced acute kidney injury, we investigate the effects of a bacterial endotoxin (lipopolysaccharide, LPS) on the basal respiration of proximal tubular epithelial cells (HK-2) by ESR oximetry. This method has shown that HK-2 cells exhibit a decreased oxygen consumption rate when treated with LPS. Surprisingly, this cellular respiration alteration persists even after the stress factor was removed. We suggested that this irreversible decrease in renal oxygen consumption after LPS challenge is related to a pathologic metabolic down-regulation such as a lack of oxygen utilization by cells.
This decrease was accompanied by increased nitric oxide (NO) production as measured by a spin trapping technique using ESR spectroscopy. This method is based on the trapping of NO by a metal-chelator complex consisting of N-methyl-D-glucamine dithiocarbamate (MGD) and reduced iron (Fe2+) forming a water-soluble NO-FeMGD complex detected by ESR. Since inducible NO synthase (iNOS) has been shown to play an important role in sepsis-induced AKI, the iNOS inhibitor L-NMMA (L-NG-monomethyl Arginine citrate) was tested in this in vitro model. L-NMMA blocked NO generation and permitted the HK-2 cells to recover a normal cellular respiration.
Overall, ESR spectroscopy and the model of HK-2 cells exposed to LPS displays some key features of inflammation-induced acute kidney injury.
