Remote ischemic preconditioning and renoprotection: from myth to a novel therapeutic option?

J Am Soc Nephrol. 2014 Feb;25(2):216-24. doi: 10.1681/ASN.2013070708. Epub 2013 Dec 5.

Abstract

There is currently no effective prophylactic regimen available to prevent contrast-induced AKI (CI-AKI), a frequent and life-threatening complication after cardiac catheterization. Therefore, novel treatment strategies are required to decrease CI-AKI incidence and to improve clinical outcomes in these patients. Remote ischemic preconditioning (rIPC), defined as transient brief episodes of ischemia at a remote site before a subsequent prolonged ischemia/reperfusion injury of the target organ, is an adaptational response that protects against ischemic and reperfusion insult. Indeed, several studies demonstrated the tissue-protective effects of rIPC in various target organs, including the kidneys. In this regard, rIPC may offer a novel noninvasive and virtually cost-free treatment strategy for decreasing CI-AKI incidence. This review evaluates the current experimental and clinical evidence for rIPC as a potential renoprotective strategy, and discusses the underlying mechanisms and key areas for future research.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / physiopathology
  • Acute Kidney Injury / prevention & control*
  • Animals
  • Autonomic Nervous System / physiopathology
  • Cardiac Surgical Procedures
  • Catecholamines / physiology
  • Clinical Trials as Topic
  • Contrast Media / adverse effects*
  • Diagnostic Techniques, Cardiovascular
  • Disease Models, Animal
  • Extremities / blood supply
  • Humans
  • Incidence
  • Inflammation / physiopathology
  • Ischemic Preconditioning*
  • Kidney / blood supply*
  • Models, Biological
  • Organ Specificity
  • Organs at Risk
  • Oxidative Stress / physiology
  • Prospective Studies
  • Reperfusion Injury / epidemiology
  • Reperfusion Injury / physiopathology
  • Reperfusion Injury / prevention & control*
  • Signal Transduction

Substances

  • Catecholamines
  • Contrast Media