Renal Hemodynamics in AKI

Abstract

Novel therapeutic interventions are required to prevent or treat AKI. To expedite progress in this regard, a consensus conference held by the Acute Dialysis Quality Initiative was convened in April of 2014 to develop recommendations for research priorities and future directions. Here, we highlight the concepts related to renal hemodynamics in AKI that are likely to reveal new treatment targets on investigation. Overall, we must better understand the interactions between systemic, total renal, and glomerular hemodynamics, including the role of tubuloglomerular feedback. Furthermore, the net consequences of therapeutic maneuvers aimed at restoring glomerular filtration need to be examined in relation to the nature, magnitude, and duration of the insult. Additionally, microvascular blood flow heterogeneity in AKI is now recognized as a common occurrence; timely interventions to preserve the renal microcirculatory flow may interrupt the downward spiral of injury toward progressive kidney failure and should, therefore, be investigated. Finally, development of techniques that permit an integrative physiologic approach, including direct visualization of renal microvasculature and measurement of oxygen kinetics and mitochondrial function in intact tissue in all nephron segments, may provide new insights into how the kidney responds to various injurious stimuli and allow evaluation of new therapeutic strategies.

Renal regeneration after acute kidney injury

“…Renal haemodynamics, including macrovascular and microvascular blood flow, are responsible for the correct supply of nutrients and oxygen and therefore are essential to regeneration. Promising haemodynamic‐based therapeutic pathways to treat AKI were recently identified, namely targeting global renal blood flow, glomerular haemodynamics, peritubular microcirculation or vascular integrity . Metabolic reprogramming has emerged as another potential player in septic AKI .…”

“…Promising haemodynamic-based therapeutic pathways to treat AKI were recently identified, namely targeting global renal blood flow, glomerular haemodynamics, peritubular microcirculation or vascular integrity. 98 Metabolic reprogramming has emerged as another potential player in septic AKI. 99 It consists of the ability of the host to reprogram metabolic signalling pathways, increasing both its immunologic resistance to microbial burden and its tolerance to inflammation-induced tissue damage.…”

Renal Oxygenation and Hemodynamics in Kidney Injury

“…It was elemental in elucidating the pathophysiology of ischemic and nephrotoxic AKI in the past, but limited information in sepsis-AKI is available. Recent publication by the Acute Dialysis Quality Initiative (ADQI) workgroup [8] has urged that a better understanding of the interactions between systemic, total renal, and glomerular hemodynamics, including the role of tubuloglomerular feedback (TGF) in AKI is needed. Better imaging techniques that would allow direct visualization of renal macro and microvasculature and tissue oxygenation are needed to provide new insights into AKI.…”

Probing renal blood volume with magnetic resonance imaging

“…Elucidating the efficacy of renoprotective strategies is essential en route to novel treatment options and effective prophylactic regimens for acute kidney injury (AKI) and chronic kidney diseases (CKD) . Current AKI and CKD therapies and prevention strategies are largely experience driven . Today's options for targeted and stratified measures are disappointingly sparse .…”