Acute renal failure: definitions, diagnosis, pathogenesis, and therapy

Schrier, Robert W.; Wang, Wei; Poole, Brian; Mitra, Amit

doi:10.1172/jci22353

Cited by 272 publications

(94 citation statements)

References 91 publications

(46 reference statements)

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“…Traditionally, septic AKI has been thought to be a consequence of a demand and perfusion mismatch, whereby renal blood flow was decreased in the midst of higher metabolic demand [89,90]. Nevertheless, in spite of conflicting animal studies, Langenberg et al [91] reported only 3 studies in humans that have directly calculated renal blood flow in septic AKI via invasive measurements.…”

Section: Endotoxin Effects On Renal Functionmentioning

confidence: 99%

Endotoxin Effects on Cardiac and Renal Functions and Cardiorenal Syndromes

et al. 2017

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Gram-negative sepsis is a major cause of morbidity and mortality in critical ill patients. Recent findings in molecular biology and in signaling pathways have enhanced our understanding of its pathogenesis and opened up opportunities of innovative therapeutic approaches. Endotoxin plays a pivotal role in the pathogenesis of multi-organ dysfunction in the setting of gram-negative sepsis. Indeed, heart and kidney impairments seem to be induced by the release of circulating pro-inflammatory and pro-apoptotic mediators triggered by endotoxin interaction with immune cells. These molecules are responsible for cellular apoptosis, autophagy, cell cycle arrest, and microRNAs activation. Therefore, the early identification of sepsis-associated acute kidney injury and heart dysfunction may improve the patient clinical outcome. In this report, we will consider the role of endotoxin in the pathogenesis of sepsis, its effects on both cardiac and renal functions, and the interactions between these 2 systems in the setting of cardiorenal syndromes (CRS), particularly in CRS type 5. Finally, we will discuss the possible role of extracorporeal therapies in reducing endotoxin levels.

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Section: Endotoxin Effects On Renal Functionmentioning

confidence: 99%

Endotoxin Effects on Cardiac and Renal Functions and Cardiorenal Syndromes

et al. 2017

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“…Acute kidney injury (AKI) affects 20 to 50% of intensive care unit (ICU) patients, and it is associated with high mortality, increased ICU length of stay and greater hospitalization cost [1][2][3][4][5]. When renal replacement therapy (RRT) is used, mortality rates can reach up to 80% [2,6].…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries

et al. 2020

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Objectives Although the majority of the global population lives in developing countries, most of the epidemiological data related to intensive care unit (ICU) acute kidney injury (AKI) comes from developed countries. This systematic review aims to ascertain the methodology of studies on ICU AKI patients in developing and developed countries, to determine whether epidemiological comparisons between these two settings are possible, and to present a summary estimate of AKI incidence. Methods A systematic review of published studies reporting AKI in intensive care units (2005-2015) identified in PubMed, LILACS, and IBECs databases was conducted. We compared developed and developing countries by evaluating study methodology, AKI reference serum creatinine definitions, population characteristics, AKI incidence and mortality. AKI incidence was calculated with a random-effects model. Results Ninety-two studies were included, one of which reported data from both country categories: 60 from developed countries (1,057,332 patients) and 33 from developing countries (34,539 patients). In 78% of the studies, AKI was defined by the RIFLE, AKIN or KDIGO criteria. Oliguria had 11 different definitions and reference creatinine 23 different values. For the metaanalysis, 38 studies from developed and 18 from developing countries were selected, with similar AKI incidence: 39.3% and 35.1%, respectively. The need for dialysis, length of ICU stay and mortality were higher in developing countries.

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“…Der reduzierte Blutfluss wurde lange als das Kennzeichen des renalen ANV angesehen, weshalb man es als "Vasomotor Nephropathie" bezeichnete [12]. Die Reduktion des Blutflusses beruht auf einer verminderten Bildung und Wirkung von vasodilatatorischen Substanzen [13] und einem Verlust der renalen Autoregulation [14], was eine persistierende Vasokonstriktion auslöst. Zusätzlich sind die Gefäße sensitiver für vasokonstriktorische Stimuli, was zu einer überproportionalen Vasokonstriktion führt [15].…”

Section: Reduzierter Renaler Blutflussunclassified

“…Zusätzlich sind die Gefäße sensitiver für vasokonstriktorische Stimuli, was zu einer überproportionalen Vasokonstriktion führt [15]. Obwohl der reduzierte renale Blutfluss unweigerlich zu einer Abnahme der GFR führt, ist dies nicht der einzige Grund für den Verlust der GFR und der renalen Schädigung [13,16]. Von größerer Bedeutung scheinen die regionalen Unterschiede in der Nierendurchblutung zu sein akutes Nierenversagen [17]: So ist der Blutfluss besonders in der äußeren Medulla kritisch reduziert [18].…”

Section: Reduzierter Renaler Blutflussunclassified

Akutes Nierenversagen – Pathophysiologie

Feldkamp¹

2010

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Acute renal failure: definitions, diagnosis, pathogenesis, and therapy

Cited by 272 publications

References 91 publications

Endotoxin Effects on Cardiac and Renal Functions and Cardiorenal Syndromes

Endotoxin Effects on Cardiac and Renal Functions and Cardiorenal Syndromes

A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries

Akutes Nierenversagen – Pathophysiologie

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