Effects of Whole Blood, Crystalloid, and Colloid Resuscitation of Hemorrhagic Shock on Renal Damage in Rats: An Ultrastructural Study By Abdurrahman O ¨ nen, Murat Kemal C ¸ igdem, Engin Deveci, Sedat Kaya, Selim Turhanog ˘ lu, and Mehmet Yaldiz Diyarbakir, Turkey Purpose: The aim of this study was to determine the effects of whole blood, crystalloid, and colloid treatment on his- topathologic damage of kidney induced by hemorrhagic shock in rats. Methods: Fifty-six male Sprague Dawley rats were divided into 8 groups. The carotid artery was cannulated, and sys- tolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), and rectal temperature (RT) were observed during the procedure. The jugular vein also was cannulated, and the SAP was decreased by aspiration of 75% of blood through the jugular vein in the control (nonresuscitated) and study (resuscitated) groups, whereas blood was not dimin- ished in the sham group. The hemorrhagic shock was per- mitted to last 45 minutes; then, the study group rats were resuscitated with heparinized shed autologous whole blood (WB), normal saline (NS), Lactated Ringer’s solution (LR), hydroxyethyl starch 6% (HES6), hydroxyethyl starch 10% (HES10), or dextran 40 (D40). Histopathologic evaluation was performed under light and electron microscope. Results: The RT, SAP, and DAP decreased, and HR increased significantly in the control and study groups during the shock period compared with those of sham group. After volume resuscitation, these parameters changed to preshock levels. Electron and light microscopic examinations of kidneys showed severe proximal tubular degeneration with moder- ate glomerular damage in the control group; moderate prox- imal tubular degeneration with mild glomerular damage in the NS, LR, HES6, and HES10 groups; and mild proximal tubular degeneration with no evidence of glomerular dam- age in the WB and D-40 groups. Conclusions: The characteristic ultrastructural features of hemorrhagic shock appear to be severe tubular degeneration and mild to moderate changes in glomeruli. Resuscitation of hemorrhagic shock with whole blood or dextran 40 solution appears to be most favorable therapy in preventing ultra- structural renal damage in rats. J Pediatr Surg 38:1642-1649. © 2003 Elsevier Inc. All rights reserved. INDEX WORDS: Hemorrhagic shock, renal failure, restora- tion of renal damage, whole blood, crystalloids, colloids, rats. T HE CLINICAL COURSE of shock is one of the most dramatic and challenging problems today. The most common form of shock in both pediatric and adult trauma patients is hypovolemic or hemorrhagic shock. 1-3 Renal hypoperfusion, which occurs in hemor- rhagic shock, creates an environment in which cellular injury and organ dysfunction can occur during the epi- sode of shock. 4 There is inadequate perfusion of blood through the tissue of the various organs, particularly the kidney and lung in many patients with circulatory shock. 5 As a consequence of protracted traumatic hem- orrhage, the regional blood flow is significantly de- creased in the kidneys. 6 Most clinical ischemic acute renal failures result from renal hypoperfusion induced by shock. 7,8 Although a considerable number of experimental pathophysiologic studies have been carried out, there are few accounts of the ultrastructural appearances in the last decade, and renal responses to shock have not been defined adequately. Early recognition and appropriate treatment of shock is the key to survival. Volume re- placement is the cornerstone of the management of hemorrhagic shock. Infusing blood and intravenous flu- ids is essential to restore the plasma volume deficits in patients suffering from hemorrhage. 9-11 However, there continues to be an ongoing debate as to the most suitable type of fluid to use for resuscitation. We aimed to determine morphologic evidence for cellular damage after 45 minutes of hemorrhagic shock and to evaluate the effects of the restoration of blood volume with whole blood (WB), normal saline (NS), hydroxyethyl starch 6% (HES6), hydroxyethyl starch 10% (HES10), Lactated Ringer’s solution (LR) and dextran 40 (D40) on his- From the Departments of Pediatric Surgery, Embryology & Histology, Anesthesiology, and Pathology, Dicle University School of Medicine, Diyarbakir, Turkey. Presented at the British Association of Pediatric Surgery Meeting, 1999. Address reprint requests to Abdurrahman O ¨ nen, MD, Assistant Professor, Department of Pediatric Surgery, Dicle University School of Medicine, 21280 Diyarbakir, Turkey. © 2003 Elsevier Inc. All rights reserved. 0022-3468/03/3811-0016$30.00/0 doi:10.1016/S0022-3468(03)00572-4 1642 Journal of Pediatric Surgery, Vol 38, No 11 (November), 2003: pp 1642-1649