Pulmonary/renal interaction

Zaccaria Ricci, Claudio Ronco

Research output: Contribution to journalArticle

Abstract

Purpose of review: Acute kidney injury contributes to the development of acute lung injury and vice-versa. Volume overload that may occur during renal impairment increases pulmonary capillary hydrostatic pressure. However, experimental evidence clearly shows that lung damage occurs even in the absence of positive fluid balance. However, acute lung injury with its attendant hypoxemia, hypercapnia and mechanical ventilation worsens renal hemodynamics and function. Recent findings: An increasing body of evidence suggests that kidney and lung interact (crosstalk) during severe insults, such as shock, trauma, and sepsis, due to a loss of the normal balance of immune, inflammatory and soluble mediators. Kidney-lung crosstalk in the critically ill constitutes a possibility to analyze mechanisms of multiple organ failure in which the kidney and the lung can play an important role. Consequently, on the clinical side, specific therapeutic options can be hypothesized for kidney/lung dysfunction. Summary: Fluid management optimization and prevention of inflammation and lung stretching are currently recommended for the treatment of acute lung and renal injury. Extracorporeal CO2 removal and renal replacement associated with extracorporeal membrane oxygenation might be interesting options for a future approach to pulmonary/renal syndrome.

Original languageEnglish
Pages (from-to)13-18
Number of pages6
JournalCurrent Opinion in Critical Care
Volume16
Issue number1
DOIs
Publication statusPublished - Feb 2010

Keywords

  • Acute kidney injury
  • Acute lung injury
  • Acute respiratory distress syndrome
  • Renal replacement therapy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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