Oxidative Stress and Acute Kidney Injury in Critical Illness: Pathophysiologic Mechanisms—Biomarkers—Interventions, and Future Perspectives

Abstract

Acute kidney injury (AKI) is a multifactorial entity that occurs in a variety of clinical settings. Although AKI is not a usual reason for intensive care unit (ICU) admission, it often complicates critically ill patients' clinical course requiring renal replacement therapy progressing sometimes to end-stage renal disease and increasing mortality. The causes of AKI in the group of ICU patients are further complicated from damaged metabolic state, systemic inflammation, sepsis, and hemodynamic dysregulations, leading to an imbalance that generates oxidative stress response. Abundant experimental and to a less extent clinical data support the important role of oxidative stress-related mechanisms in the injury phase of AKI. The purpose of this article is to present the main pathophysiologic mechanisms of AKI in ICU patients focusing on the different aspects of oxidative stress generation, the available evidence of interventional measures for AKI prevention, biomarkers used in a clinical setting, and future perspectives in oxidative stress regulation.

Oxidative stress in hemodialysis: Causative mechanisms, clinical implications, and possible therapeutic interventions

“…OS in chronic kidney disease (CKD) results from increased production of prooxidant molecules such as reactive oxygen species (ROS) and nitric oxide (NO), insufficient clearance of oxidative products, and deficient antioxidant defense mechanisms . Accumulation of ROS and NO trigger the activation of inflammatory mediators and subsequently promotes oxidation and modification of lipids, proteins, carbohydrates, and nucleic acids—such as deoxyribonucleic acid—(DNA) . Antioxidants can be either endogenous or dietary supplemented molecules (Table ).…”

“…2 Accumulation of ROS and NO trigger the activation of inflammatory mediators and subsequently promotes oxidation and modification of lipids, proteins, carbohydrates, and nucleic acids-such as deoxyribonucleic acid-(DNA). 3 Antioxidants can be either endogenous or dietary supplemented molecules (Table 1).…”

Elevated Serum Ferritin Levels Are Predictive of Renal Function Recovery among Patients with Acute Kidney Injury

“…The AKI pathogenesis is deeply complex as a result of many insults, as well as the involvement of different individual and overlapping pathophysiological pathways. Accordingly, many different molecular mechanisms have been implicated in the pathogenesis of AKI, although kidney injury caused by reactive oxygen species (ROS) is recognized as one of the fundamental principles (Kasuno et al 2014;Virzi et al 2015;Pavlakou et al 2017). ROS may injure the kidney in multiple ways.…”

Selenium in Cardiac Surgery

“…Se deficiency is always accompanied by decreased GPX activity and thereby increased oxidative stress, which may trigger the development of acute kidney injury and other forms of organ failure …”