title: The microcirculation of the septic kidney.
abstract: The renal microcirculation plays a major role in the delivery of blood and oxygen to the kidney. In sepsis, alterations in renal microvascular perfusion, in conjunction with increased oxygen requirements, may contribute to renal failure even when renal macrovascular perfusion is preserved. In this review, we discuss the pathophysiology of the renal microcirculation during sepsis and how it contributes to acute kidney injury. Endothelial dysfunction largely is owing to inflammatory, oxidative, and nitrosative factors. Coagulative disorders and glycocalyx disruption also may contribute to the microcirculatory dysfunction. New technologies in experimental models and human beings are being developed to explore renal microcirculation in vivo. These technologies will allow a better understanding of the pathophysiopathology of the renal microcirculation and will help guide specific therapeutic strategies in sepsis-induced acute kidney injury.
authors: Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: lara.zafrani@sls.aphp.fr.
authors: Lara
authors: L
authors: Zafrani
authors: Department of Anesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, INSERM 1160, Paris, France.
authors: Didier
authors: D
authors: Payen
authors: Department of Critical Care, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Diderot, Paris, France.
authors: Elie
authors: E
authors: Azoulay
authors: Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors: Can
authors: C
authors: Ince
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D042783:Endothelial Cells / Q000378:metabolism; D004730:Endothelium, Vascular / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation; D007668:Kidney / Q000098:blood supply* / Q000378:metabolism; D008833:Microcirculation; D015538:Nitrosation; D018384:Oxidative Stress; D012079:Renal Circulation; D018805:Sepsis / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*
keywords: Sepsis; acute kidney injury; microcirculation