title: Glomerular haemodynamics, the renal sympathetic nervous system and sepsis-induced acute kidney injury.
abstract: BACKGROUND
  To describe recent insights into glomerular haemodynamics in septic acute kidney injury (AKI).
  
  
  METHODS
  We reviewed the literature with particular emphasis on recent findings in animal experiments and human studies in relation to renal macro- and micro-renal haemodynamics during septic AKI.
  
  
  RESULTS
  The dominant paradigm is that septic AKI is due to decreased renal perfusion with ischaemic loss of glomerular filtration rate (GFR), ischaemic tubular cell injury and acute tubular necrosis (ATN). However, recent experimental and human studies challenge this view of the pathogenesis of septic AKI. In addition, rapid post-mortem and experimental histological studies do not support ATN as the histological substrate of septic AKI. Finally, more recent experimental evidence suggests that changes in the glomerular and peri-glomerular haemodynamics provide a more likely explanation for the loss of GFR seen in the early phases of septic AKI.
  
  
  CONCLUSIONS
  Despite a long-standing paradigm that septic AKI is due to renal hypo-perfusion and associated ATN, experimental and human studies increasingly suggest that changes in the state of the glomerular and peri-glomerular micro-vasculature are a more likely additional explanation for this condition.
authors.affiliation: Department of Anaesthesia and Intensive Care, Uboldo Hospital, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Calzavacca
authors.affiliation: Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Clive N
authors.initials: CN
authors.lastname: May
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Monash University School of Epidemiology and Public Health, Melbourne, Australia Department of Intensive Care, Austin Health, Heidelberg, VIC, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000818:Animals; D005919:Glomerular Filtration Rate; D006801:Humans; D007678:Kidney Glomerulus / Q000294:innervation* / Q000503:physiopathology; D007683:Kidney Tubular Necrosis, Acute / Q000209:etiology / Q000503:physiopathology*; D018805:Sepsis / Q000150:complications*; D013564:Sympathetic Nervous System / Q000473:pathology*
keywords: acute kidney injury; afferent arteriole; efferent arteriole; renal blood flow; sepsis