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- Title
Short-term beneficial effects of methylene blue on kidney damage in septic shock patients.
- Authors
Heemskerk, Suzanne; Van Haren, Frank M. P.; Foudraine, Norbert A.; Peters, Wilbert H. M.; Van Der Hoeven, Johannes G.; Russel, Frans G. M.; Masereeuw, Rosalinde; Pickkers, Peter
- Abstract
We previously demonstrated that upregulation of renal inducible nitric oxide synthase (iNOS) is associated with proximal tubule injury during systemic inflammation in humans. In this study we investigated the short-term effect of methylene blue (MB), an inhibitor of the NO pathway, on kidney damage and function in septic shock patients. A prospective clinical study conducted in an intensive care unit. Nine patients (four men, five women, mean age 71 ± 3 years) with confirmed or suspected bacterial infection and with refractory septic shock defined as a mean arterial pressure ≤ 70 mmHg despite norepinephrine infusion ≥ 0.2 μg/kg per minute. A 4 h continuous intravenous infusion of 1 mg/kg MB per hour. The urinary excretion of NO metabolites decreased with median 90% (range 75–95%) from baseline to 6 h after MB administration. The first 24 h creatinine clearance improved by 51% (18–173%) after MB treatment but was still strongly impaired. During the first 6 h after the start of MB treatment both the urinary excretion of cytosolic glutathione S-transferase A1-1 and P1-1, markers for proximal and distal tubule damage, respectively, decreased by 45% (10–70%) and 70% (40–85) vs. baseline. After termination of the MB infusion the NO metabolites and markers of tubular injury returned to pretreatment levels. In septic patients with refractory shock short-term infusion of MB is associated with a decrease in NO production and an attenuation of the urinary excretion of renal tubular injury markers.
- Subjects
NITRIC-oxide synthases; METHYLENE blue; SEPTIC shock; INTENSIVE care units; METABOLITES
- Publication
Intensive Care Medicine, 2008, Vol 34, Issue 2, p350
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-007-0867-9