Renal replacement therapy (RRT) is an important therapeutic strategy in patients with AKI. Several studies suggested that RRT is able to maintain selleck chemical Brefeldin A adequate fluid, electrolyte and acid-base balance but can also favorably influence the outcome of AKI patients by removing a broad range of inflammatory substances [14-16]. Various mechanisms have been proposed for such removal: diffusion, convection and adsorption [17]. Indeed, the adsorption matrixes may be useful tools to remove different inflammatory mediators by non-selective simultaneous adsorption [18,19]. Based on previous studies, Amberchrom CG161 M, a rigid, highly cross-linked microreticular hydrophobic adsorbent polymer was chosen as having the most convenient particle and pore size [20].

The aim of this study was to establish an in vitro model of tubular injury based on the effects of septic plasma and to evaluate whether the unselective removal of circulating plasma factors by the Amberchrom resin could be protective on septic plasma-induced tubular cell injury.Materials and methodsPatientsFrom June to December 2008, 10 critically ill patients (mean age: 63.9 �� 11.2 years; gender: seven males, three females) admitted to the intensive care unit (ICU) of the San Bortolo Hospital in Vicenza, Italy, were enrolled in the study. Inclusion criteria were: the presence of septic shock in accordance to the criteria defined by the American College of Chest Physicians and by the Society of Critical Care Medicine [21]; and the presence of AKI determined by the evaluation of serum creatinine or urinary output (inclusion in the failure group of RIFLE criteria) [22,23].

Exclusion criteria were: age younger than 18 years, solid organ or bone marrow transplantation, hemorrhagic dysfunction, thrombophilia, chronic renal failure, glomerulonephritis or collagenopathies. The severity of illness was assessed by Sequential Organ Failure Assessment (SOFA) score at the moment of ICU admission and at the start of the dialytic treatment. As control, plasma was obtained from five healthy volunteers. Informed consent was obtained according to the Declaration of Helsinki and the study was authorized by the Internal Review Board of the San Bortolo Hospital.In vitro plasma adsorption: experimental designThe Amberchrom CG161 M resin (Rohm and Haas Company, Philadelphia, PA, USA). was activated in 50% methanol and extensively washed in isotonic saline.

Two ml of the resin were packed into chromatography columns with an inner diameter of 1 cm (Biorad, Hercules, CA, USA). Prior to filling with the resin, columns were treated with silane (Sigma, St. Louis, MO, USA). The resin beds were perfused with a solution of 4% human serum albumin in PBS containing a cocktail of recombinant Dacomitinib cytokines at the following concentrations (pg/ml): TNF-�� (600), IL-1�� (200), IL-10 (350), IL-8 (400), and IL-6 (300).