Clinical and Experimental Nephrology

, Volume 19, Issue 6, pp 1015–1023 | Cite as

Comparison of two fluid solutions for resuscitation in a rabbit model of crush syndrome

  • De-yang Kong
  • Li-rong Hao
  • Li Zhang
  • Qing-gang Li
  • Jian-hui Zhou
  • Suo-zhu Shi
  • Fei Zhu
  • Yan-qiu Geng
  • Xiang-mei Chen
Original Article



Crush syndrome is a common injury, the main characteristics of which include acute kidney injury. However, there is still lack of reliable animal model of crush syndrome, and it also remains controversial as to which type of fluid should be chosen as a more appropriate treatment option for prevention and treatment of acute kidney injury.


The rabbits were crushed at the lower limbs for 6 h with 36 times the body weight, which means the pressure of each leg was also 36 times the body weight. Fluid resuscitation was performed from 1 h prior to the end of the crush treatment until 24 h after the reperfusion. Tissue, blood and urine samples were collected at predetermined time points before and after reperfusion. Twelve rabbits in each group were taken for survival observation for 72 h.


The model group showed elevated serum creatine kinase, aspartate aminotransferase, alanine aminotransferase, and K+ level, reduced serum Ca2+ level and Na+ level, and increased serum creatinine and blood urea nitrogen levels, neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1 (p < 0.05). The 0.9 % normal saline (SAL) group and SAL plus 6 % hydroxyethyl starch 130/0.4 SAL/HES group showed reduced serum creatinine and blood urea nitrogen levels (p < 0.05). The SAL/HES group also showed reduced serum IL-6 and IL-10 levels (p < 0.05). The 72 h survival rate of the SAL/HES group was higher than that of the model group (p < 0.05).


The rabbit model of crush syndrome showed clinical features consistent with those of crush syndrome. There was no significant difference in the ability of preventing AKI after a crush injury between the two fluid solutions, while SAL/HES can improve the survival rate.


Crush syndrome Fluid resuscitation Inflammatory response Oxidative stress 



This work was partially supported by a research grant from Chinese PLA 12th Five-Year Plan for Medical Sciences (BWS11J027), a grant from National Natural Science Foundation of China (81170643), and a grant from National Key Technology R&D Program (2011BAI10B00).

Conflict of interest

The authors declare no conflict of interest.


  1. 1.
    He Q, Wang F, Li G, et al. Crush syndrome and acute kidney injury in the Wenchuan Earthquake. J Trauma. 2011;70:1213–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Better OS, Abassi ZA. Early fluid resuscitation in patients with rhabdomyolysis. Nat Rev Nephrol. 2011;7:416–22.CrossRefPubMedGoogle Scholar
  3. 3.
    Murata I, Ooi K, Sasaki H, et al. Characterization of systemic and histologic injury after crush syndrome and intervals of reperfusion in a small animal model. J Trauma. 2011;70:1453–63.CrossRefPubMedGoogle Scholar
  4. 4.
    James MF. Place of the colloids in fluid resuscitation of the traumatized patient. Curr Opin Anaesthesiol. 2012;25:248–52.CrossRefPubMedGoogle Scholar
  5. 5.
    Ogilvie MP, Pereira BM, McKenney MG, et al. First report on safety and efficacy of hetastarch solution for initial fluid resuscitation at a level 1 trauma center. J Am Coll Surg. 2010;210:870–82.CrossRefPubMedGoogle Scholar
  6. 6.
    James MF, Michell WL, Joubert IA, et al. Resuscitation with hydroxyethyl starch improves renal function and lactate clearance in penetrating trauma in a randomized controlled study: the FIRST trial (fluids in resuscitation of severe trauma). Br J Anaesth. 2011;107:693–702.CrossRefPubMedGoogle Scholar
  7. 7.
    Urbano J, López-Herce J, Solana MJ, et al. Comparison of normal saline, hypertonic saline and hypertonic saline colloid resuscitation fluids in an infant animal model of hypovolemic shock. Resuscitation. 2012;83:1159–65.CrossRefPubMedGoogle Scholar
  8. 8.
    Aksu U, Bezemer R, Yavuz B, et al. Balanced vs unbalanced crystalloid resuscitation in a near-fatal model of hemorrhagic shock and the effects on renal oxygenation, oxidative stress, and inflammation. Resuscitation. 2011;83:767–73.CrossRefPubMedGoogle Scholar
  9. 9.
    Ozgüç H, Kahveci N, Akköse S, et al. Effects of different resuscitation fluids on tissue blood flow and oxidant injury in experimental rhabdomyolysis. Crit Care Med. 2005;33:2579–86.CrossRefPubMedGoogle Scholar
  10. 10.
    Finfer S, Liu B, Taylor C, et al. Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units. Crit Care. 2010;14:185.CrossRefGoogle Scholar
  11. 11.
    Inan N, Iltar S, Surer H, et al. Effect of hydroxyethyl starch 130/0.4 on ischaemia/reperfusion in rabbit skeletal muscle. Eur J Anaesthesiol. 2009;26:160–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Walker AM, Lee K, Dobson GM, et al. The viscous behaviour of HES 130/0.4 (Voluven(R)) and HES 260/0.45 (Pentaspan(R)). Can J Anaesth. 2012;59:288–94.CrossRefPubMedGoogle Scholar
  13. 13.
    Westphal M, James MF, Kozek-Langenecker S, et al. Hydroxyethyl starches: different products–different effects. Anesthesiology. 2009;111:187–202.CrossRefPubMedGoogle Scholar
  14. 14.
    Dubin A, Dubin A, Pozo MO, et al. Comparison of 6% hydroxyethyl starch 130/0.4 and saline solution for resuscitation of the microcirculation during the early goal-directed therapy of septic patients. J Crit Care. 2010;25(659):e1–8.PubMedGoogle Scholar
  15. 15.
    Akimau P, Yoshiya K, Hosotsubo H, Takakuwa T, Tanaka H, et al. New experimental model of crush injury of the hindlimbs in rats. J Trauma. 2005;58:51–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Schick MA, Isbary TJ, Schlegel N, et al. The impact of crystalloid and colloid infusion on the kidney in rodent sepsis. Intensive Care Med. 2010;36:541–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Wang Y, Zhang L, Cai GY, et al. Fasudil ameliorates rhabdomyolysis-induced acute kidney injury via inhibition of apoptosis. Ren Fail. 2011;33:811–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Sun L, Xu S, Zhou M, et al. Effects of cysteamine on MPTP-induced dopaminergic neurodegeneration in mice. Brain Res. 2010;1335:74–82.CrossRefPubMedGoogle Scholar
  19. 19.
    Bywaters EGL, Popjak G. Experimental crushing injury. Peripheral circulatory collapse and other effects of muscle necrosis in the rabbit. Surg Gyn Obst. 1942;75:612–27.Google Scholar
  20. 20.
    El-Abdellati E, Eyselbergs M, Sirimsi H, et al. An observational study on rhabdomyolysis in the intensive care unit. Exploring its risk factors and main complication: acute kidney injury. Ann Intensive Care. 2013;3:8.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Sever MS, Vanholder R, Lameire N. Management of crush-related injuries after disasters. N Engl J Med. 2006;354:1052–63.CrossRefPubMedGoogle Scholar
  22. 22.
    Antonopoulos CN, Kalkanis A, Georgakopoulos G, et al. Neutrophil gelatinase-associated lipocalin in dehydrated patients: a preliminary report. BMC Res Notes. 2011;4:435.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Ferreira EL, Terzi RG, Silva WA, et al. Early colloid replacement therapy in a near-fatal model of hemorrhagic shock. Anesth Analg. 2005;101:1785–91.CrossRefPubMedGoogle Scholar
  24. 24.
    Rubinstein I, Abassi Z, Coleman R, et al. Involvement of nitric oxide system in experimental muscle crush injury. J Clin Invest. 1998;101:1325–33.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Sonoi H, Matsumoto N, Ogura H, et al. The effect of antithrombin on pulmonary endothelial damage induced by crush injury. Shock. 2009;32:593–600.CrossRefPubMedGoogle Scholar
  26. 26.
    Kaszaki J, Wolfárd A, Szalay L, et al. Pathophysiology of ischemia-reperfusion injury. Transplant Proc. 2006;38:826–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Arand M, Melzner H, Kinzl L, et al. Early inflammatory mediator response following isolated traumatic brain injury and other major trauma in humans. Langenbeck’s Arch Surg. 2001;386:241–8.CrossRefGoogle Scholar
  28. 28.
    Chang CH, Hsiao CF, Yeh YM. Circulating interleukin-6 level is a prognostic marker for survival in advanced nonsmall cell lung cancer patients treated with chemotherapy. Int J Cancer. 2013;132(9):1977–85.CrossRefPubMedGoogle Scholar
  29. 29.
    Shimazaki J, Matsumoto N, Ogura H, et al. Systemic involvement of high-mobility group box 1 protein and therapeutic effect of anti-high-mobility group box 1 protein antibody in a rat model of crush injury. Shock. 2012;37:634–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Sotnikova R, Nedelčevová J, Navarová J, et al. Protection of the vascular endothelium in experimental situations. Interdiscip Toxicol. 2011;4:20–6.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2015

Authors and Affiliations

  • De-yang Kong
    • 1
    • 2
  • Li-rong Hao
    • 2
  • Li Zhang
    • 1
  • Qing-gang Li
    • 1
  • Jian-hui Zhou
    • 1
  • Suo-zhu Shi
    • 1
  • Fei Zhu
    • 1
  • Yan-qiu Geng
    • 1
  • Xiang-mei Chen
    • 1
  1. 1.Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney DiseasesNational Clinical Research Center of Kidney DiseasesBeijingChina
  2. 2.Department of Nephrology1st Affiliated Hospital of Harbin Medical UniversityHarbinChina

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