Renal Hemodynamics in AKI: In Search of New Treatment Targets.
Novel therapeutic interventions are required to prevent or treat AKI. To expedite progress in this regard, a consensus conference held by the Acute Dialysis Quality Initiative was convened in April of 2014 to develop recommendations for research priorities and future directions. Here, we highlight the concepts related to renal hemodynamics in AKI that are likely to reveal new treatment targets on investigation. Overall, we must better understand the interactions between systemic, total renal, and glomerular hemodynamics, including the role of tubuloglomerular feedback. Furthermore, the net consequences of therapeutic maneuvers aimed at restoring glomerular filtration need to be examined in relation to the nature, magnitude, and duration of the insult. Additionally, microvascular blood flow heterogeneity in AKI is now recognized as a common occurrence; timely interventions to preserve the renal microcirculatory flow may interrupt the downward spiral of injury toward progressive kidney failure and should, therefore, be investigated. Finally, development of techniques that permit an integrative physiologic approach, including direct visualization of renal microvasculature and measurement of oxygen kinetics and mitochondrial function in intact tissue in all nephron segments, may provide new insights into how the kidney responds to various injurious stimuli and allow evaluation of new therapeutic strategies.
First Medical Department and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Teaching Hospital in Plzen, Plzen, Czech Republic;
Martin
M
Matejovic
Department of Intensive Care, Erasmus Medical Center University Hospital, Rotterdam, The Netherlands;
Can
C
Ince
Department of Medicine, Division of Intensive Care Medicine and Division of Nephrology, Veterans Affairs Medical Center, Washington, DC;
Lakhmir S
LS
Chawla
Nephrology-Hypertension Division, University of California, San Diego School of Medicine and Veterans Affairs San Diego Healthcare System, San Diego, California;
Roland
R
Blantz
Department of Medicine, Division of Nephrology and Department of Cellular and Integrative Physiology, Indiana University School of Medicine and the Rouderbush Veterans Affairs Medical Center, Indianapolis, Indiana;
Bruce A
BA
Molitoris
Division of Nephrology, Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia Health System, Charlottesville, Virginia; MHR9R@hscmail.mcc.virginia.edu.
Mitchell H
MH
Rosner
Division of Nephrology, Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia Health System, Charlottesville, Virginia;
Mark D
MD
Okusa
Center for Critical Care Nephrology and Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and.
John A
JA
Kellum
Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital and the International Renal Research Institute, Vicenza, Italy.
Claudio
C
Ronco
D058186:Acute Kidney Injury / Q000503:physiopathology* / Q000628:therapy*; D035843:Biomedical Research; D006439:Hemodynamics; D006801:Humans; D012079:Renal Circulation
acute renal failure; clinical nephrology; hemodynamics and vascular; regulation