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{"title":"Pathophysiology of Acute Kidney Injury in Critical Illness: A Narrative Review.","authors":"Luis A Juncos, Patrick M Wieruszewski, Kianoush Kashani","doi":"10.1002/cphy.c210028","DOIUrl":null,"url":null,"abstract":"<p><p>Acute kidney injury (AKI) is a syndrome that entails a rapid decline in kidney function with or without injury. The consequences of AKI among acutely ill patients are dire and lead to higher mortality, morbidity, and healthcare cost. To prevent AKI and its short and long-term repercussions, understanding its pathophysiology is essential. Depending on the baseline kidney histology and function reserves, the number of kidney insults, and the intensity of each insult, the clinical presentation of AKI may differ. While many factors are capable of inducing renal injury, they can be categorized into a few processes. The three primary processes reported in the literature are hemodynamic changes, inflammatory reactions, and nephrotoxicity. The majority of patients with AKI will suffer from more than one during their development and/or progression of AKI. Moreover, the development of one usually leads to the instigation of another. Thus, the interactions and progression between these mechanisms may determine the severity and duration of the AKI. Other factors such as organ crosstalk and how our concurrent therapies interact with these mechanisms complicate the pathophysiology of the progression of the AKI even further. In this narrative review article, we describe these three main pathophysiological processes that lead to the development and progression of AKI. © 2022 American Physiological Society. Compr Physiol 12: 1-14, 2022.</p>","PeriodicalId":10573,"journal":{"name":"Comprehensive Physiology","volume":"12 4","pages":"3767-3780"},"PeriodicalIF":4.2000,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"5","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Comprehensive Physiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/cphy.c210028","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PHYSIOLOGY","Score":null,"Total":0}
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Abstract
Acute kidney injury (AKI) is a syndrome that entails a rapid decline in kidney function with or without injury. The consequences of AKI among acutely ill patients are dire and lead to higher mortality, morbidity, and healthcare cost. To prevent AKI and its short and long-term repercussions, understanding its pathophysiology is essential. Depending on the baseline kidney histology and function reserves, the number of kidney insults, and the intensity of each insult, the clinical presentation of AKI may differ. While many factors are capable of inducing renal injury, they can be categorized into a few processes. The three primary processes reported in the literature are hemodynamic changes, inflammatory reactions, and nephrotoxicity. The majority of patients with AKI will suffer from more than one during their development and/or progression of AKI. Moreover, the development of one usually leads to the instigation of another. Thus, the interactions and progression between these mechanisms may determine the severity and duration of the AKI. Other factors such as organ crosstalk and how our concurrent therapies interact with these mechanisms complicate the pathophysiology of the progression of the AKI even further. In this narrative review article, we describe these three main pathophysiological processes that lead to the development and progression of AKI. © 2022 American Physiological Society. Compr Physiol 12: 1-14, 2022.
危重疾病急性肾损伤的病理生理学:述评。
急性肾损伤(AKI)是一种伴有或不伴有损伤的肾功能迅速下降的综合征。急性AKI患者的后果是可怕的,导致更高的死亡率、发病率和医疗费用。为了预防AKI及其短期和长期的影响,了解其病理生理学是必不可少的。根据肾脏的基本组织学和功能储备、肾脏损伤的数量和每次损伤的强度,AKI的临床表现可能不同。虽然许多因素都能引起肾损伤,但它们可以分为几个过程。文献报道的三个主要过程是血流动力学改变、炎症反应和肾毒性。在AKI的发展和/或进展过程中,大多数AKI患者会遭受不止一种的痛苦。此外,一个人的发展通常会导致另一个人的煽动。因此,这些机制之间的相互作用和进展可能决定AKI的严重程度和持续时间。其他因素,如器官串扰以及我们的同步治疗如何与这些机制相互作用,使AKI进展的病理生理学进一步复杂化。在这篇叙述性综述文章中,我们描述了导致AKI发生和发展的三个主要病理生理过程。©2022美国生理学会。中国生物医学工程学报(英文版),2016。
本文章由计算机程序翻译,如有差异,请以英文原文为准。