Lung Dysfunction and Chronic Kidney Disease: A Complex Network of Multiple Interactions

Abstract

Chronic kidney disease (CKD) is a progressive disease that affects > 10% of the total population worldwide or >800 million people. CKD poses a particularly heavy burden in low- and middle-income countries, which are least able to cope with its consequences. It has become one of the leading causes of death worldwide and is one of the few non-communicable diseases where the number of related deaths has increased over the last two decades. The high number of people affected, and the significant negative impact of CKD should be a reason to increase efforts to improve prevention and treatment. The interaction of lung and kidney leads to highly complex and difficult clinical scenarios. CKD significantly affects the physiology of the lung by altering fluid homeostasis, acid-base balance and vascular tone. In the lung, haemodynamic disturbances lead to the development of alterations in ventilatory control, pulmonary congestion, capillary stress failure and pulmonary vascular disease. In the kidney, haemodynamic disturbances lead to sodium and water retention and the deterioration of renal function. In this article, we would like to draw attention to the importance of harmonising the definitions of clinical events in pneumology and renal medicine. We would also like to highlight the need for pulmonary function tests in routine clinical practise for the management of patients with CKD, in order to find new concepts for pathophysiological based disease-specific management strategies.

Evaluation of Comorbidity Burden on Disease Progression and Mortality in Patients with Interstitial Pneumonia with Autoimmune Features: a Retrospective Cohort Study

“…For example, CVD is a treatable comorbidity frequently observed in IPF and has been linked to worse outcomes, with proposed mechanisms including systemic in ammation, hypercoagulability, platelet activation, and oxidative stress (32)(33)(34). A complex relationship between CKD and lung disease progression, particularly through alterations of uid homeostasis and acid-base balance, has also been demonstrated (35,36). A potential explanation for the observed association of fracture and lung disease progression, in this study, is the increased prevalence of steroid use in patients with more severe disease which can thereby increase fracture risk.…”

Association between pulmonary function and rapid kidney function decline: a longitudinal cohort study from CHARLS

“…Chronic kidney disease (CKD) and chronic lower respiratory diseases pose substantial challenges to global public health, marked by an unfavourable prognosis characterised by elevated mortality rates 1. In recent years, the spotlight has focused on the correlation between lung and kidney health, as lung and kidney function are closely related, both in health and in disease 2 3. Reduced lung function has been linked to an increased long-term risk of developing chronic obstructive pulmonary disease (COPD) and higher prevalences of diabetes, obstructive sleep apnea, hypertension and heart attacks 4.…”

“… 1 In recent years, the spotlight has focused on the correlation between lung and kidney health, as lung and kidney function are closely related, both in health and in disease. 2 3 Reduced lung function has been linked to an increased long-term risk of developing chronic obstructive pulmonary disease (COPD) and higher prevalences of diabetes, obstructive sleep apnea, hypertension and heart attacks. 4 Respiratory complications may directly or indirectly result from circulating uremic toxins, volume overload, electrolyte disorders, acid-base imbalances, cardiovascular alterations and malnutrition, as the estimated glomerular filtration rate (eGFR) declines.…”

A Rare Case of Atypical Anti-glomerular Basement Membrane Disease

“…Its typical presentation includes swiftly advancing renal failure, with or without lung complications. In 60-80% of instances, patients face kidney and lung issues, while the rest may encounter kidney-specific or, in rare cases, pulmonary-only symptoms [ 2 ].…”