Mechanisms and Mediators of Lung Injury After Acute Kidney Injury

Overview

Journal Nat Rev Nephrol

Specialty Nephrology

Date 2015 Oct 6

PMID 26434402

Citations 76

Authors

Sarah Faubel

Charles L Edelstein

Affiliations

Soon will be listed here.

Abstract

Acute kidney injury (AKI) is a common complication in hospitalized patients, associated with >50% mortality in those in intensive care who require renal replacement therapy. Data suggest that AKI is a systemic disease that adversely affects the immune system and organ function, and in this way contributes to the high mortality observed in affected patients. Data from patients and animal models indicate that AKI adversely affects the lungs. Respiratory complications are common in patients with AKI and include pulmonary oedema, respiratory failure requiring mechanical ventilation, prolonged duration of mechanical ventilation, and prolonged weaning from mechanical ventilation. The development of respiratory failure in patients with AKI greatly increases the risk of death. Data from animal models support the notion that cardiogenic pulmonary oedema (from volume overload) and non-cardiogenic pulmonary oedema (from endothelial injury due to inflammation and apoptosis) can occur in AKI. In this Review we discuss the clinical, epidemiologic, and animal data that provide insights into the mechanisms by which AKI can lead to lung injury and respiratory complications. Elucidation of the mechanisms of lung injury and respiratory complications after AKI is essential to develop effective therapies and reduce the high mortality associated with AKI and respiratory failure.

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References

Frank H, Seligman A, Fine J . Further Experiences with Peritoneal Irrigation for Acute Renal Failure: Including a Description of Modifications in Method. Ann Surg. 1948; 128(3):561-608. PMC: 1514060. View

White L, Santora R, Cui Y, Moore F, Hassoun H . TNFR1-dependent pulmonary apoptosis during ischemic acute kidney injury. Am J Physiol Lung Cell Mol Physiol. 2012; 303(5):L449-59. PMC: 3468427. DOI: 10.1152/ajplung.00301.2011. View

Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I . Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators. Intensive Care Med. 2007; 33(9):1563-70. DOI: 10.1007/s00134-007-0754-4. View

Simmons E, Himmelfarb J, Sezer M, Chertow G, Mehta R, Paganini E . Plasma cytokine levels predict mortality in patients with acute renal failure. Kidney Int. 2004; 65(4):1357-65. DOI: 10.1111/j.1523-1755.2004.00512.x. View

Colletti L, Cortis A, Lukacs N, Kunkel S, Green M, Strieter R . Tumor necrosis factor up-regulates intercellular adhesion molecule 1, which is important in the neutrophil-dependent lung and liver injury associated with hepatic ischemia and reperfusion in the rat. Shock. 1998; 10(3):182-91. DOI: 10.1097/00024382-199809000-00006. View

Payen D, de Pont A, Sakr Y, Spies C, Reinhart K, Vincent J . A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care. 2008; 12(3):R74. PMC: 2481469. DOI: 10.1186/cc6916. View

Ronco C, House A, Haapio M . Cardiorenal syndrome: refining the definition of a complex symbiosis gone wrong. Intensive Care Med. 2008; 34(5):957-62. DOI: 10.1007/s00134-008-1017-8. View

Star R . Treatment of acute renal failure. Kidney Int. 1998; 54(6):1817-31. DOI: 10.1046/j.1523-1755.1998.00210.x. View

Peterson B, Brooks J, HYDE R . Lung fluid balance during acute renal failure in sheep. J Appl Physiol (1985). 1986; 60(4):1333-40. DOI: 10.1152/jappl.1986.60.4.1333. View

10.

Wacker W, MERRILL J . Uremic pericarditis in acute and chronic renal failure. J Am Med Assoc. 1954; 156(8):764-5. DOI: 10.1001/jama.1954.02950080012005. View

11.

Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann L, Druml W, Bauer P . Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004; 15(6):1597-605. DOI: 10.1097/01.asn.0000130340.93930.dd. View

12.

Chertow G, Lazarus J, Paganini E, Allgren R, Lafayette R, Sayegh M . Predictors of mortality and the provision of dialysis in patients with acute tubular necrosis. The Auriculin Anaritide Acute Renal Failure Study Group. J Am Soc Nephrol. 1998; 9(4):692-8. DOI: 10.1681/ASN.V94692. View

13.

DEPASS S, Jacobson H, POPPEL M, Stein J . Pulmonary congestion and edema in uremia. J Am Med Assoc. 1956; 162(1):5-9. DOI: 10.1001/jama.1956.02970180007002. View

14.

Tsalik E, Willig L, Rice B, van Velkinburgh J, Mohney R, McDunn J . Renal systems biology of patients with systemic inflammatory response syndrome. Kidney Int. 2015; 88(4):804-14. PMC: 4591107. DOI: 10.1038/ki.2015.150. View

15.

Liangos O, Wald R, Obell J, Price L, Pereira B, Jaber B . Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2007; 1(1):43-51. DOI: 10.2215/CJN.00220605. View

16.

Bhargava R, Altmann C, Andres-Hernando A, Webb R, Okamura K, Yang Y . Acute lung injury and acute kidney injury are established by four hours in experimental sepsis and are improved with pre, but not post, sepsis administration of TNF-α antibodies. PLoS One. 2013; 8(11):e79037. PMC: 3827109. DOI: 10.1371/journal.pone.0079037. View

17.

Wiedemann H, Wheeler A, Bernard G, Thompson B, Hayden D, deBoisblanc B . Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006; 354(24):2564-75. DOI: 10.1056/NEJMoa062200. View

18.

Murugan R, Wen X, Shah N, Lee M, Kong L, Pike F . Plasma inflammatory and apoptosis markers are associated with dialysis dependence and death among critically ill patients receiving renal replacement therapy. Nephrol Dial Transplant. 2014; 29(10):1854-64. PMC: 4173817. DOI: 10.1093/ndt/gfu051. View

19.

Pike F, Murugan R, Keener C, Palevsky P, Vijayan A, Unruh M . Biomarker Enhanced Risk Prediction for Adverse Outcomes in Critically Ill Patients Receiving RRT. Clin J Am Soc Nephrol. 2015; 10(8):1332-9. PMC: 4527029. DOI: 10.2215/CJN.09911014. View

20.

KRAMER A, POSTLER G, Salhab K, Mendez C, Carey L, Rabb H . Renal ischemia/reperfusion leads to macrophage-mediated increase in pulmonary vascular permeability. Kidney Int. 1999; 55(6):2362-7. DOI: 10.1046/j.1523-1755.1999.00460.x. View