Randomized clinical trial of the effects of methylprednisolone on renal function after major vascular surgery

Abstract

Methylprednisolone administration altered the cytokine profile favourably but adversely affected postoperative renal function.

The Utility of Steroids in Pediatric Cardiac Operations*

“…In contrast to the findings in the current meta-analysis, plasma creatinine, adjusted fluid balance, and urine output at 36 hours postoperative were slightly worse in the 2-dose steroid group(12). Although limited by the lack of a placebo group these findings are consistent with adult studies(15). …”

Critical Role of Mast Cell Chymase in Mouse Abdominal Aortic Aneurysm Formation

“…Such treatment in patients with AAA increases IL-10 (a generally anti-inflammatory cytokine) and decreases IL-6 (a pro-inflammatory cytokine) and levels of the inflammatory marker C-reactive protein in serum 33,34. In contrast to these beneficial effects, our data showed that patients who received glucocorticoid therapy had a nearly doubled rate of AAA growth (3.54±0.49 vs. 1.97±0.19 mm/year, mean±SEM, P =0.01) compared with patients who did not receive the therapy, although this treatment also significantly reduced the serum chymase levels (10.77±0.31 vs. 12.34±0.24, ng/ml, mean±SEM, P <0.04).…”

Dexamethasone Ameliorates Renal Ischemia-Reperfusion Injury

“…Indeed, it is significantly less than those found after intravenous pulse glucocorticoid therapy used in a few major vascular surgical studies [7][8][9][10] to protect against renal IRI, where serum concentrations can reach 60 to 200 M. 37 The plausible mechanism of GR-mediated activation of the MEK/ ERK 1/2 module in proximal tubular cells is partly speculative. The cytosolic nonliganded GR is a part of a multiprotein complex in which, among other proteins, two molecules of heat shock protein 90 (hsp90), as well as one molecule each of hsp70 and hsp56 are known to be included.…”

“…4 -6 For decades, glucocorticoids (GCs) have been successfully used in the treatment of numerous clinical conditions for their anti-inflammatory and immunosuppressive effects. GCs have been studied as renoprotective agents in a few small postvascular surgical studies and in varied experimental settings [7][8][9][10] associated with renal IRI. However, the effects of GCs on renal IRI have never been thoroughly studied.…”