The Clinical Investigation Of Acute Renal Failure And Empirical Studies

Backgroud and Objective Acute renal failure is the severe clinical syndrom which develops in all the department of the hospital. The morbidity of ARF is obviously increasing, and it is more and more severe. Recently, the mortality associated with ARF is still high. To investigate the clinical features, such as etiology, treatment,prognosis, and the factors which influencing the development of ARF,and using renal ischemia-reperfusion injury rat model to explore whether magnolin attenuates renal IRI in rats and the possible pretective mechanism. So we can raise the level of early diagnosis and treatment, and improve the prognosis of ARF.Methods This study has two parts. The first part is prospective study. The ARF patients in all department of our hospital from Dec 2003 to Dec 2006, which conform to the the defination of ARF were recruited.All the informations of recruited ARF patients were entered into the computer,and were analyzed using a Statistical Analysis system(SAS 6.12) software. The second part is empirical study. 45 male SD rats were randomized to the following three groups: Sham operation group(group 1,n=5),Ischemia- reperfusion group (group 2,n=20,in thisgroup,20 rats were divided into four subgroups according to the time of reperfusion,that is 1h, 3h, 6h, 24h after reperfusion,each subgroup has 5 rats),magnolin treatment group(group 3,n=20,20 rats were divided into four subgroups as group 2). Rats were anesthesized and undertook lapotomy. Sham operation group were treated without occlusion of left renal artery,only right nephrectomized. In group2 and group 3,right nephrectomy was performed as soon as occlusion of left renal artery for 60 minutes and then recanalization. magnolin were administered intravenously at a dose of 2mg/kg 5 minutes before reperfusion in group 3. The group 2 was IV normal saline equivalently. When the experiment was finished, left nephrectomy was performed in every group ,at the same time ,blood samples were obtained for measurement of serum levels of creatine(Cr) and blood urea nitrogen(BUN). On one hand,every left kidney was used for histological examination and mimmuohistochemical analysis of intercellular adhesion molecule-1 (ICAM-1),P-selectin,TLR2 and TLR4.Results 1. There are 320 patients developed ARF in the past three years.They were 198 males and 122 females with mean age (56.6±18.1 ) years old.The patterns of ARF were pre-renal ARF(39.1%),renal parenchymal ARF(49.1%) Post-renal ARF(11.9%). The morbidity rate was 0.27%, and the mortality rate was 31.9%. In the elderly,the mortality rate was significantly higher than non-elderly. The heart failure,respiratory failure, malignant cancer were the risk factors of the mortality.2. (1)Renal function change: Compared with group 1,the serum levels of Cr and BUN in group 2 were significantly higher than those in group 1. Compared with group 2, the serum levels of Cr and BUN in the magnolin treatment were lower signifcantly in group 3. (2)Renal cellular damages in group 2 showed more severe than those in group 1.Compared with group 1,expression of P-selectin,ICAM-1,TLR2 and TLR4 in kidney increased significantly in group 2.What's more, compared with group 2,renal histologic injury were attenuated significantly by magnolin, as well as expression of renal P-selectin, ICAM-1, TLR 2 and TLR4 was depressed significantly by magnolin in group 3. Conclusions Both the morbidity and mortality rate of ARF are high,and increasing from year to year.Respiratory failure,heart failure,Malig- nant cancer are the independent risk factors of mortality. Our results indicate that magnolin can attenuate renal ischemia-reperfusion injury, which may be probably through inhibition of inflammation mediated by adhesion molecule and TLR.