[Pulmonary-renal crosstalk in the critically ill patient].
Despite advances in the development of renal replacement therapy, mortality of acute renal failure remains high, especially when occurring simultaneously with distant organic failure as it is in the case of the acute respiratory distress syndrome. In this update, birideccional deleterious relationship between lung and kidney on the setting of organ dysfunction is reviewed, which presents important clinical aspects of knowing. Specifically, the renal effects of acute respiratory distress syndrome and the use of positive-pressure mechanical ventilation are discussed, being ventilator induced lung injury one of the most common models for studying the lung-kidney crosstalk. The role of renal failure induced by mechanical ventilation (ventilator-induced kidney injury) in the pathogenesis of acute renal failure is emphasized. We also analyze the impact of the acute renal failure in the lung, recognizing an increase in pulmonary vascular permeability, inflammation, and alteration of sodium and water channels in the alveolar epithelial. This conceptual model can be the basis for the development of new therapeutic strategies to use in patients with multiple organ dysfunction syndrome.
Unidad de Paciente Crítico Pediátrico, Hospital Clínico Metropolitano La Florida, Santiago, Chile. Electronic address: adonosofuentes@gmail.com.
Alejandro
A
Donoso F
Unidad de Paciente Crítico Pediátrico, Hospital Clínico Metropolitano La Florida, Santiago, Chile.
Daniela
D
Arriagada S
Unidad de Paciente Crítico Pediátrico, Hospital El Carmen Maipú, Santiago, Chile; Escuela de Medicina Veterinaria, Facultad de Ecología y Recursos Naturales, Centro de Investigación de Medicina Veterinaria, Universidad Andrés Bello, Santiago, Chile.
Pablo
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Cruces R
D058186:Acute Kidney Injury / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016638:Critical Illness; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology; D009102:Multiple Organ Failure / Q000503:physiopathology / Q000628:therapy*; D011175:Positive-Pressure Respiration / Q000379:methods; D017582:Renal Replacement Therapy / Q000379:methods; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D055397:Ventilator-Induced Lung Injury / Q000503:physiopathology
Acute distress syndrome; Acute renal failure; Apoptosis; Falla renal aguda; Intercomunicación pulmón-riñón; Lung-kidney crosstalk; Mechanical ventilation; Síndrome de distrés respiratorio agudo; Ventilación mecánica