Repeated remote ischemic preconditioning and isoflurane anesthesia in an experimental model of renal ischemia-reperfusion injury

Abstract Background In animal studies, remote ischemic preconditioning (RIPC) and anesthetic preconditioning are successful in reducing renal ischemia reperfusion injury (IRI), however the protective effect of RIPC may be improved by repeating the RIPC stimulus. Methods Sprague-Dawley rats underwent unilateral nephrectomy followed by 30 min of renal pedicle clamping. Animals were allocated into six groups: sham, control (IRI), RepISO (daily isoflurane anesthesia), RIPC (single dose isoflurane anesthesia and single dose RIPC), RepISO\u2009+\u2009RIPC (7-day isoflurane anesthesia and single dose RIPC) and RepISO\u2009+\u2009RepRIPC (7-day isoflurane anesthesia with 7-day RIPC). RIPC was applied by 3\ud75 min of cuff inflation on both thighs. Serum creatinine and urea levels were measured and histology was obtained at day two. Results RepISO diminished renal IRI, as reflected by a significant reduction in serum creatinine levels as compared to the control group, 170\u2009\ub1\u200974 resp. 107\u2009\ub1\u200929 \u3bcmol/L. The other preconditioning protocols showed similar reduction in serum creatinine levels as compared to the control group. No significant differences were observed between the different preconditioning protocols. For urea levels, only RepISO\u2009+\u2009RIPC resulted in significantly lower levels as compared to the control group, 14\u2009\ub1\u20094 resp. 22\u2009\ub1\u20097 mmol/L ( p \u2009=\u20090.010). In the preconditioning groups only RepISO showed less histological damage as compared to controls 1.73\u2009\ub1\u20091.19 resp. 2.91\u2009\ub1\u20091.22 ( p \u2009=\u20090.032). Conclusions In this study no additional protective effect of repeated ischemic preconditioning was observed as compared to single dose RIPC. Repeated administration of isoflurane provided stronger protection against renal IRI as compared to single dose isoflurane