The Pathophysiological Hypothesis of Kidney Damage during Intra-Abdominal Hypertension

Villa, Gianluca; Samoni, Sara; Rosa, Silvia De; Ronco, Claudio

doi:10.3389/fphys.2016.00055

Cited by 35 publications

(27 citation statements)

References 18 publications

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“…Alternatively, Woods [23] suggested that an overall increase in renal blood flow is the main mechanism, rather than a temporary variation in FF. The observed decrease in renal vascular resistance in response to protein load also supports this theory [24][25][26][27] and demonstrates that afferent arteriolar vasodilation is probably the main mechanism involved in RFR [28] . Another alternative is that the GFR increase during RST might be obtained through the recruitment of "dormant cortical nephrons," uninvolved in filtration during resting conditions but potentially available under stress [29] .…”

Section: Introductionsupporting

confidence: 65%

Rationale for the Evaluation of Renal Functional Reserve in Living Kidney Donors and Recipients: A Pilot Study

Spinelli¹,

Sharma²,

Villa³

et al. 2017

Nephron

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Background: In living kidney transplantation, preoperative donors' renal functional reserve (RFR) may correlate with postoperative residual renal function in both donors and recipients. The aim of this study was to evaluate the donors' RFR before transplantation and to compare basal and stress renal function before and after transplantation in both donors and recipients. Methods: Seven pairs of living kidney donors and recipients were considered for this observational study. RFR was measured with a renal stress test (RST) before and after the kidney transplantation through an oral protein loading test (1 g/kg of body weight). RFR was defined as the difference between the maximum value of creatinine clearance after protein load (stress glomerular filtration rate, sGFR) and baseline creatinine clearance (basal GFR, bGFR). Results: Before transplantation, a significant difference between sGFR and bGFR (p = 0.04) was observed in donors, with an RFR = 30.6 (11.9-41.5) mL/min/1.73 m². After kidney transplantation, sGFR was similar to bGFR for both donors and recipients (p = 0.13), with a limited RFR (7.9 [6.70-19.25] and 14.90 [-6.67 to 25.53] mL/min/1.73 m², respectively). The sum of the donor's and recipient's post-transplant sGFR was similar to the pre-transplant donor's sGFR (p = 0.73). Conclusion: RST is a safe, feasible, easy, and an inexpensive tool that is able to quantify RFR. In living kidney transplantation, it can be used in clinical practice to measure the original global filtration capacity of the donor's kidneys (sGFR) and to quantify the susceptibility of donors and recipients in developing postoperative kidney dysfunction. However, further studies with an adequate sample size and follow-up period are needed to test this hypothesis.

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Section: Introductionsupporting

confidence: 65%

Rationale for the Evaluation of Renal Functional Reserve in Living Kidney Donors and Recipients: A Pilot Study

Spinelli¹,

Sharma²,

Villa³

et al. 2017

Nephron

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“…Last but not the least, the current study did not examine the relationship between intra-abdominal pressure and renal function. An elevation in intra-abdominal pressure or intra-abdominal hypertension (IAH) has long been recognized as a risk factor for the development of altered renal function among critically ill patients [ 32 , 33 ]. IAH has been reported to occur in 51–76% of patients with septic shock and in 33–41% of patients after emergency abdominal surgery and is associated with AKI and mortality [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

A combination of SOFA score and biomarkers gives a better prediction of septic AKI and in-hospital mortality in critically ill surgical patients: a pilot study

et al. 2018

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BackgroundSepsis is a syndrome characterized by a constellation of clinical manifestations and a significantly high mortality rate in the surgical intensive care unit (ICU). It is frequently complicated by acute kidney injury (AKI), which, in turn, increases the risk of mortality. Therefore, it is of paramount importance to identify those septic patients at risk for the development of AKI and mortality. The objective of this pilot study was to evaluate several different biomarkers, including NGAL, calprotectin, KIM-1, cystatin C, and GDF-15, along with SOFA scores, in predicting the development of septic AKI and associated in-hospital mortality in critically ill surgical patients.MethodsPatients admitted to the surgical ICU were prospectively enrolled, having given signed informed consent. Their blood and urine samples were obtained and subjected to enzyme-linked immunosorbent assay (ELISA) to determine the levels of various novel biomarkers. The clinical data and survival outcome were recorded and analyzed.ResultsA total of 33 patients were enrolled in the study. Most patients received surgery prior to ICU admission, with abdominal surgery being the most common type of procedure (27 patients (81.8%)). In the study, 22 patients had a diagnosis of sepsis with varying degrees of AKI, while the remaining 11 were free of sepsis. Statistical analysis demonstrated that in patients with septic AKI versus those without, the following were significantly higher: serum NGAL (447.5 ± 35.7 ng/mL vs. 256.5 ± 31.8 ng/mL, P value 0.001), calprotectin (1030.3 ± 298.6 pg/mL vs. 248.1 ± 210.7 pg/mL, P value 0.049), urinary NGAL (434.2 ± 31.5 ng/mL vs. 208.3 ± 39.5 ng/mL, P value < 0.001), and SOFA score (11.5 ± 1.2 vs. 4.4 ± 0.5, P value < 0.001). On the other hand, serum NGAL (428.2 ± 32.3 ng/mL vs. 300.4 ± 44.3 ng/mL, P value 0.029) and urinary NGAL (422.3 ± 33.7 ng/mL vs. 230.8 ± 42.2 ng/mL, P value 0.001), together with SOFA scores (10.6 ± 1.4 vs. 5.6 ± 0.8, P value 0.003), were statistically higher in cases of in-hospital mortality. A combination of serum NGAL, urinary NGAL, and SOFA scores could predict in-hospital mortality with an AUROC of 0.911.ConclusionsThis pilot study demonstrated a promising panel that allows an early diagnosis, high sensitivity, and specificity and a prognostic value for septic AKI and in-hospital mortality in surgical ICU. Further study is warranted to validate our findings.Electronic supplementary materialThe online version of this article (10.1186/s13017-018-0202-5) contains supplementary material, which is available to authorized users.

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“…All these hemodynamic effects might occur in patients with an already reduced kidney perfusion, directly related to the cause of respiratory failure (e.g. intra-abdominal hypertension [10]), or for the concomitant alteration of neuro-hormonal pathway (e.g. those aiming to retain salt and water to maintain an adequate vascular filling pressure to counteract the peripheral vasodilation due to hypercapnia [20,21]).…”

Section: Pathophysiological Relationship Between Ckd and Akimentioning

confidence: 99%

“…In line with the RFR reduction, the extent of the minimum metabolic insult able to overcome the maximum achievable renal clearance is progressively decreased. In this context, the susceptibility of each CKD patient to develop AKI is directly proportional to the RFR reduction [10] (fig. 1).…”

Section: Pathophysiological Relationship Between Ckd and Akimentioning

confidence: 99%

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Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

Rosa

Samoni²,

Villa³

et al. 2017

Blood Purif

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3,608

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Patients with chronic kidney disease (CKD) are at high risk for developing critical illness and for admission to intensive care units (ICU). ‘Critically ill CKD patients' frequently develop an acute worsening of renal function (i.e. acute-on-chronic, AoC) that contributes to long-term kidney dysfunction, potentially leading to end-stage kidney disease (ESKD). An integrated multidisciplinary effort is thus necessary to adequately manage the multi-organ damage of those kidney patients and contemporaneously reduce the progression of kidney dysfunction when they are critically ill. The aim of this review is to describe (1) the pathophysiological mechanisms underlying the development of AoC kidney dysfunction and its role in the progression toward ESKD; (2) the most common clinical presentations of critical illness among CKD/ESKD patients; and (3) the continuum of care for CKD/ESKD patients from maintenance hemodialysis/peritoneal dialysis to acute renal replacement therapy performed in ICU and, vice-versa, for AoC patients who develop ESKD.

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The Pathophysiological Hypothesis of Kidney Damage during Intra-Abdominal Hypertension

Cited by 35 publications

References 18 publications

Rationale for the Evaluation of Renal Functional Reserve in Living Kidney Donors and Recipients: A Pilot Study

Rationale for the Evaluation of Renal Functional Reserve in Living Kidney Donors and Recipients: A Pilot Study

A combination of SOFA score and biomarkers gives a better prediction of septic AKI and in-hospital mortality in critically ill surgical patients: a pilot study

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

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