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David M. Haybron, MS; Michael C. Townsend, MD; William W. Hampton, MD; William J. Schirmer, MD; James M. Schirmer; Donald E. Fry, MD

Arch Surg. 1987;122(3):328-331.

Abstract
• Whether acute renal failure following overwhelming bacterial septicemia is initially a consequence primarily of a cytotoxic insult or a perfusion insufficiency remains unclear. To assess the effects of intra-abdominal sepsis on the distribution of renal blood flow and renal cell bioenergy status, the glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and energy-charge ratios were measured in rats following cecal ligation/puncture (CLP) or sham laparotomies. The CLP animals demonstrated a decrease in ERPF of 42% and 58% from sham groups at ten and 20 hours, respectively. The GFR showed similar but more severe impairments of 53% and 71% at ten and 20 hours, respectively, following insult despite moderate increases in cardiac output. The disproportionate decrease in GFR over ERPF supports the hypothesis of a corticomedullary redistribution of renal blood flow in sepsis. Renal energy charge, unchanged at ten hours, decreased significantly at 20 hours. Diminished renal perfusion and the redistribution of renal blood flow precedes and may contribute to the renal cell bioenergy derangements in septic acute renal failure.

(Arch Surg 1987;122:328-331)

Author Affiliations
From the Department of Surgery, Case Western Reserve University, Cleveland, and Veterans Administration Medical Center, Cleveland. Drs Townsend and Schirmer are Dudley P. Allen Research Fellows for the Department of Surgery, Case Western Reserve University.

Footnotes
Accepted for publication Sept 19, 1986.

Read before the Tenth Annual Surgical Symposium of the Association of Veterans Administration Surgeons, Washington, DC, May 9, 1986.

Reprint requests to Department of Surgery, 112W, Veterans Administration Medical Center, 10701 East Blvd, Cleveland, OH 44106 (Dr Fry).

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