Surgical Sepsis and Organ Crosstalk: The Role of the Kidney

Department of Surgery, The Methodist Hospital and Research Institute, Houston Texas, USA.
Journal of Surgical Research (Impact Factor: 2.12). 12/2010; 167(2):306-15. DOI: 10.1016/j.jss.2010.11.923
Source: PubMed

ABSTRACT Acute kidney injury (AKI) is a common complication of hospitalized patients, and clinical outcomes remain poor despite advances in renal replacement therapy. The accepted pathophysiology of AKI in the setting of sepsis has evolved from one of simple decreased renal blood flow to one that involves a more complex interaction of intra-glomerular microcirculatory vasodilation combined with the local release of inflammatory mediators and apoptosis. Evidence from preclinical AKI models suggests that crosstalk occurs between kidneys and other organ systems via soluble and cellular inflammatory mediators and that this involves both the innate and adaptive immune systems. These interactions are reflected by genomic changes and abnormal rates of cellular apoptosis in distant organs including the lungs, heart, gut, liver, and central nervous system. The purpose of this article is to review the influence of AKI, particularly sepsis-associated AKI, on inter-organ crosstalk in the context of systemic inflammation and multiple organ failure (MOF).

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Available from: Frederick Alan Moore, Jul 07, 2014
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    • "Indeed, we often experience oliguria in the perioperative management of patients with acute generalized peritonitis due to GI perforation and ileus. This oliguria results in reduced renal perfusion due to hypovolemia caused by systemic inflammatory response syndrome [19], sepsis [20], and intra-abdominal hypertension [21]. Empirically, we treat oliguria by infusion of extracellular fluid. "
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    Journal of critical care 10/2012; DOI:10.1016/j.jcrc.2012.07.020 · 2.19 Impact Factor
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    • "Although we almost invariably study organ systems in isolation from one another (even in the design of our in vivo experiments), the reality is that organ systems are constantly interacting and influencing the behavior of other systems . Consider, for example, the inextricably interwoven functions of the cardiovascular and renal systems, both in health and disease (for reviews see White et al., 2011; Merhaut and Trupp, 2010; Iwanaga and Miyazaki, 2010). The renin-angiotensin system (RAS) exhibits enormous influence over the cardiovascular system via direct and indirect hormonal signals (for reviews see Harrison- Bernard, 2009; Kumar et al., 2009; Rohini et al., 2010; Nguyen, 2010), just as the kidneys are utterly dependent upon appropriate blood flow for plasma filtration and urine formation (for reviews see Daniels and Maisel, 2007; Patel, 2009). "
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    Critical care (London, England) 11/2011; 15(6):R277. DOI:10.1186/cc10559
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