PCO2 electrodes at the surface of the kidney detect ischaemia

Under ischaemic (anaerobic) conditions there will be an accumulation of CO2 in the tissue secondary to a build up of protons that is buffered by HCO3. We reasoned that CO2 could be measured at the surface of the kidney by PCO2 electrodes to detect ischaemic conditions.

Anaesthetized, mechanically ventilated pigs (25-30 kg) were investigated. Two acute porcine models, one of haemorrhagic shock and one of renal artery stenosis were used. Renal blood flow was gradually decreased, either by successive episodes of bleeding through the arterial cannula or by successive snaring of the renal artery.

In both models we found that with decreased blood flow but maintained aerobic metabolism (supply independence) PCO2 both at the surface of the kidney and in the renal vein increased by 2-3 kPa. Thus, the tissue-venous PCO2 difference did not change much. At DO2crit, i.e., at the transition to supply-dependent O2 consumption, the tissue PCO2 started to increase rapidly, as did the tissue-venous PCO2 difference. This is compatible with the notion that a hallmark of ischaemia is decreased ability of the blood to transport away waste products because the contact between large parts of tissue and blood is virtually non-existent. In the renal artery stenosis model kidney surface PCO2 values rose from a baseline of 6.6 +/- 0.6 kPa (mean +/- SEM) to a value near DO2crit of 10.6 +/- 0.8 kPa, reaching a final value of 29.9 +/- 3.5 kPa at no flow. PCO2 in the renal vein, however, reached a maximum of only 8.2 +/- 0.6 kPa. Numbers very similar to these were also found in the haemorrhagic model. The urine production decreased before the onset of ischaemia. When surface PCO2 values increased sharply indicating ischaemia, the urine production was zero. Lactate production by the kidney correlated very well with increasing tissue PCO2 values further corroborating that anaerobic metabolism was detected with the electrodes.

We conclude that PCO2 electrodes placed at the surface of the kidney detect renal cortical ischaemia.