Plasma Utilization Exacerbates Renal Cortex Inflammation in a Rodent Model of Hemorrhagic Shock and Resuscitation.

Abstract

Background and hypothesis: Resuscitation strategies incorporating fresh frozen plasma have become the standard of care in the management of traumatic hemorrhagic shock. While plasma resuscitation has been shown to augment the circulation and reduce inflammation within the splanchnic and pulmonary circulation, its global effect on the kidney remains unknown. We hypothesized that plasma would improve intra-renal blood flow and reduce parenchymal inflammation when compared to resuscitation with lactated ringer's.

Methods: Animals were randomized into four groups (n = 8): a) baseline, b) hemorrhagic shock alone, c) lactated ringer's resuscitation, and d) fresh frozen plasma resuscitation. Multiplex immunoassays were used to evaluate cytokine and chemokine signaling within the renal cortex and immunohistochemistry was used to identify leukocyte infiltration. Doppler ultrasonography was used to evaluate changes in blood flow and maximum kidney diameter during hemorrhagic shock and resuscitation.

Results: While no difference in resistive index (surrogate for blood flow) within the renal artery or parenchymal vessels was observed between resuscitation strategies, plasma resulted in increased transverse kidney diameter. Plasma administration promoted cytokine/chemokine signaling, resulting in increased infiltration of leukocytes within the renal cortex when compared to lactated ringer's.

Conclusion: Although the clinical benefits of plasma resuscitation mandate its utilization, our current findings highlight the complexities of plasma resuscitation. While the increase in renal diameter may be related to augmentation of the microcirculation, plasma resuscitation did not enhance macro-circulatory blood flow. Furthermore, plasma resuscitation appears to exacerbate inflammation within the renal cortex after hemorrhage. The downstream physiologic implications of plasma-induced inflammation warrant further exploration.