doi: 10.1097/ALN.0b013e3182702a64

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Yap, Steven C. M.D.; Lee, H. Thomas M.D., Ph.D.*

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In Reply:

We thank Mayeur et al. for their interest in our review on acute kidney injury and extra renal organ dysfunction.1 As stated in our review, “single-insult” kidney injury models including complete renal ischemia, nephrotoxins, nephrectomy, or renal hypoperfusion do not completely recapitulate the multifactorial causes of clinical acute kidney injury. Single-insult models of kidney injury, however, have been invaluable in demonstrating the effects of acute kidney injury-mediated remote and multiorgan dysfunction.2 We agree with Mayeur et al. that the hemorrhage and resuscitation model is used to produce multiorgan injury as well as systemic inflammatory response syndrome.3,4 However, we disagree that it is a single-insult model of organ injury. The hemorrhage and resuscitation method is actually a “two-insult model” of multiorgan injury, as this model requires a period of controlled hemorrhage followed by resuscitation with shed blood. Resuscitation with shed blood exacerbates as well as causes multiorgan injury by promoting systemic inflammatory response, platelet activation, increased neutrophil recruitment and microthrombi formation.4
Steven C. Yap, M.D., H. Thomas Lee, M.D., Ph.D.*
*College of Physicians and Surgeons of Columbia University, New York, New York.
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1. Yap SC, Lee HT. Acute kidney injury and extrarenal organ dysfunction: New concepts and experimental evidence. Anesthesiology. 2012;116:1139–48

2. Park SW, Chen SW, Kim M, Brown KM, olls JK, D’Agati VD, Lee HT. Cytokines induce small intestine and liver injury after renal ischemia or nephrectomy. Lab Invest. 2011;91:63–84

3. Mayeur N, Minville V, Jaafar A, Allard J, Al Saati T, Guilbeau-Frugier C, Fourcade O, Girolami JP, Schaak S, Tack I. Morphologic and functional renal impact of acute kidney injury after prolonged hemorrhagic shock in mice. Crit Care Med. 2011;39:2131–8

4. Harr JN, Moore EE, Wohlauer MV, Fragoso M, Gamboni F, Liang X, Banerjee A, Silliman CC. Activated platelets in heparinized shed blood: The “second hit” of acute lung injury in trauma/hemorrhagic shock models. Shock. 2011;36:595–603

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