Pulmonary Consequences of Acute Kidney Injury

Abstract

Mortality rates among critically ill patients with acute kidney injury (AKI) requiring renal replacement therapy typically exceed 50%, rates that have not improved significantly despite ongoing advancements in renal replacement therapy. A growing body of animal and human data have accumulated over the past 2 decades that have shown that AKI is associated with a series of distant organ effects that may contribute to the persistently high mortality of AKI. In this review, we describe the pulmonary sequelae of AKI, focusing on mechanisms of pulmonary edema in the context of traditional complications of AKI (eg, volume overload, acidosis) and nontraditional complications of AKI (eg, systemic inflammation). We review the complexities of volume management in patients with kidney and lung injury and subsequently delve into the clinical and basic science data on the mediators of lung injury after AKI. With an in-depth understanding of how the traditional and nontraditional effects of AKI can combine to produce pulmonary complications, effective management and therapeutic strategies may be developed.

Preconditioning mesenchymal stromal cells with flagellin enhances the anti‑inflammatory ability of their secretome against lipopolysaccharide‑induced acute lung injury

“…The causes of ALI include a disruption in the balance of pro- and anti-inflammatory factors, an imbalance between oxidation and anti-oxidation, disorders of the coagulation system and abnormal apoptosis ( 31 ). In particular, LPS, which comprises part of the wall of Gram-negative bacteria, can increase the expression of inflammatory factors, promote inflammatory cells to enter lung tissue and increase alveolar-capillary barrier permeability ( 28 , 32 ).…”

Incidence and risk factors of kidney impairment on patients with COVID-19: A meta-analysis of 10180 patients

“…Kidney damage can be caused by circulating inflammatory factors such as tumor necrosis factor (TNF)-α and interleukin (IL)-6, which are originated from pneumonia, happened in the lung. Furthermore, the local inflammatory response from injury and death renal cells will accelerate damage in the development of AKI as well as other organs [31,32]. Thus, to reduce the possibility of developing into critically illness and the mortality risk for COVID-19 patients, applying more protective measures and supportive medication interventions is necessary, which has a significant influence for the kidney care of patients, including the application of drugs with mild kidney adverse effects, renal replacement therapies (RRT) like blood filtering and purification treatments etc.…”

Acute Kidney Injury in patients with pneumonia

“…Гиперволемия -результат накопления жидкости в организме в связи с нарушением выделительной функции почек, а также сердечной недостаточности на фоне депрессии миокарда под влиянием уремических токсинов. Вторым механизмом возникновения отека легких является увеличение проницаемости легочных капилляров на фоне нормоволемии [30]. Таким образом, отек легких при пульмо-ренальном синдроме по патогенезу является комбинированным: гидростатическим и негидростатическим [56].…”

“…Осложнения ОПП, являющиеся причинами высо-Таблица 1. Традиционные и нетрадиционные осложнения ОПП [30]. В ряде случаях имеет место и ятрогенное повреждение легких и почек, например при ИВЛ при тяжелой пневмонии [31,32].…”