Renal effects of nitric oxide in endotoxemia

Am J Respir Crit Care Med. 2001 Nov 15;164(10 Pt 1):1890-5. doi: 10.1164/ajrccm.164.10.2103140.


Nitric oxide (NO) is postulated to play a key role in the pathophysiology of renal failure in sepsis. Whether the renal effects of increased NO are beneficial or harmful remains unclear. In a porcine model of lipopolysaccharide (LPS)-induced shock, we evaluated the effect of LPS on glomerular filtration rate (GFR) and renal blood flow (RBF). We then administered the nonselective nitric oxide synthase (NOS) inhibitor N(G)-L-arginine methyl ester (L-NAME), and compared its effects on GFR and RBF with those of S-methylisothiourea (SMT), a selective NOS inhibitor, and those of saline. We postulated that SMT, by maintaining constitutive NO, would be more beneficial than either L-NAME or saline. LPS infusion decreased mean arterial pressure (MAP), and increased cardiac output, RBF, and medullary NO content. The increased RBF was diverted to the medulla. There was no evidence of renal dysfunction in the saline-resuscitated group. Both NOS inhibitors increased MAP but decreased RBF, but only L-NAME reduced GFR and increased sodium excretion and renal oxygen extraction. We conclude that NO in endotoxemia is beneficial because it maintains RBF and GFR. Additionally, selective NOS inhibition did not offer any advantages over saline resuscitation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / drug therapy
  • Acute Kidney Injury / metabolism*
  • Acute Kidney Injury / microbiology*
  • Analysis of Variance
  • Animals
  • Blood Pressure / drug effects
  • Cardiac Output / drug effects
  • Disease Models, Animal*
  • Endotoxemia / complications*
  • Endotoxemia / drug therapy
  • Endotoxemia / metabolism*
  • Endotoxemia / physiopathology
  • Female
  • Glomerular Filtration Rate / drug effects
  • Isothiuronium / analogs & derivatives*
  • Isothiuronium / pharmacology
  • Lipopolysaccharides / adverse effects*
  • NG-Nitroarginine Methyl Ester / pharmacology
  • Nitric Oxide / physiology*
  • Nitric Oxide Synthase / antagonists & inhibitors
  • Nitric Oxide Synthase / pharmacology
  • Oxygen Consumption
  • Renal Circulation / drug effects
  • Resuscitation / methods
  • Shock, Septic / complications*
  • Shock, Septic / drug therapy
  • Shock, Septic / metabolism*
  • Shock, Septic / physiopathology
  • Swine


  • Lipopolysaccharides
  • Isothiuronium
  • Nitric Oxide
  • Nitric Oxide Synthase
  • S-methylisothiopseudouronium
  • NG-Nitroarginine Methyl Ester