Effect of Combined Treatment of Ketorolac and Remote Ischemic Preconditioning on Renal Ischemia-Reperfusion Injury in Patients Undergoing Partial Nephrectomy: Pilot Study

• Main Authors: Hae Keum Kil, Ji Young Kim, Young Deuk Choi, Hye Sun Lee, Tae Kwang Kim, Ji Eun Kim
• Format: Article
• Language: English
• Published: MDPI AG 2018-11-01
• Series: Journal of Clinical Medicine
• Subjects: acute kidney injury; ischemic preconditioning; ketorolac
• Online Access: https://www.mdpi.com/2077-0383/7/12/470

We evaluated postoperative renal function in patients with/without combined therapy of ketorolac and remote ischemic preconditioning during partial nephrectomy. Sixteen patients were randomly allocated to either the ketorolac combined with RIPC group (KI, <i>n</i> = 8) or control group (<i>n</i> = 8). The KI group received both remote ischemic preconditioning before surgery and intravenous ketorolac of 1 mg/kg before renal artery clamping. Renal parameters were measured before induction, after anesthesia induction, and 2, 12, 24, 48, and 72 h after renal artery declamping. Acute kidney injury was assessed by Acute Kidney Injury Network criteria. The estimated glomerular filtration rate decreased in both groups, but then increased significantly at 48 h and 72 h after declamping only in the KI group compared to 24 h (<i>p</i> = 0.001 and <i>p</i> = 0.016). Additionally, it was higher at 48 h and 72 h after declamping in the KI group compared to the control group (<i>p</i> = 0.025 and <i>p</i> = 0.044). The incidence of acute kidney injury was significantly reduced in the KI group (13%) compared to the control group (83%) (<i>p</i> = 0.026). FE_Na was markedly increased at 2 h after declamping, and recovered in both groups, but it was more significant at 12 h after declamping in the KI group (<i>p</i> = 0.022). Urinary N-acetyl-1-&#946;-D-glucosoaminidase and serum neutrophil gelatinase-associated lipocalin were similar (<i>p</i> = 0.291 and <i>p</i> = 0.818). There is a possibility that combined therapy of ketorolac and remote ischemic preconditioning prior to ischemia may alleviate renal dysfunction and reduce the incidence of acute kidney injury in patients undergoing partial nephrectomy.