Intensive Care Medicine

, Volume 33, Issue 9, pp 1498–1500 | Cite as

Acute kidney injury in sepsis: Is renal blood flow more than just an innocent bystander?

  • Martin Matejovic
  • Peter Radermacher
  • Michael Joannidis

Sir, The kidney is a common “victim organ” of various insults in critically ill patients, and, conversely, renal dysfunction adds substantially to the morbidity and mortality of these patients [1, 2]. Even relatively minor increments in serum creatinine levels coincide with markedly increased morbidity and mortality [3], highlighting the potentially important role of the kidney dysfunction during the natural history of critical illness. Sepsis and septic shock are the dominant cause of acute kidney injury (AKI), accounting for nearly 50% of episodes of acute renal failure [4]. Nevertheless, the exact understanding of pathophysiologic mechanisms of sepsis-induced AKI that would allow the development of new therapeutic strategies to prevent AKI or to hasten its recovery still remains a mystery.

In this issue of “Intensive Care Medicine” Langenberg et al. [5] present a provocative, hypothesis-generating insight into the behavior of renal hemodynamics both during the injurious and the...



This work was supported by research grant MSM 0021620819 (Replacement of and support to some vital organs).


  1. 1.
    Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C (2005) Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Acute renal failure in critically ill patients: a multinational, multicenter study. J Am Med Assoc 294:813–818CrossRefGoogle Scholar
  2. 2.
    Joannidis M, Metnitz PG (2005) Epidemiology and natural history of acute renal failure in the ICU. Crit Care Clin 21:239–249PubMedCrossRefGoogle Scholar
  3. 3.
    Chertow GM, Soroko SH, Paganini EP, Cho KC, Himmelfarb J, Ikizler TA, Mehta RL (2006) Mortality after acute renal failure: models for prognostic stratification and risk adjustment. Kidney Int 70:1120–1126PubMedCrossRefGoogle Scholar
  4. 4.
    Schrier RW, Wang W (2004) Acute renal failure and sepsis. N Engl J Med 351:159–169PubMedCrossRefGoogle Scholar
  5. 5.
    Langenberg C, Wan L, Egi M, May CN, Bellomo R (2007) Renal blood flow and function during recovery from experimental septic acute kidney injury. Intensive Care Med DOI  10.1007/s00134-007-0734-8
  6. 6.
    Langenberg C, Bellomo R, Maz C, Wan L, Moritoki E, Morgera S (2005) Renal blood flow in sepsis. Crit Care 9:R363–R374PubMedCrossRefGoogle Scholar
  7. 7.
    Molitoris BA (2005) Renal blood flow in sepsis: a complex issue. Crit Care 9:327–328PubMedCrossRefGoogle Scholar
  8. 8.
    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative Workgroup (2004) Acute renal failure: definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212PubMedCrossRefGoogle Scholar
  9. 9.
    Langenberg C, Wan L, Egi M, May CN, Bellomo R (2006) Renal blood flow in experimental septic acute renal failure. Kidney Int 69:1996–2002PubMedCrossRefGoogle Scholar
  10. 10.
    Schmidt C, Hocherl K, Bucher M (2007) Regulation of renal glucose transporters during severe inflammation. Am J Physiol Renal Physiol 292:F804–F811PubMedCrossRefGoogle Scholar
  11. 11.
    Friedrich JO, Adhikari N, Herridge MS, Beyene J (2005) Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med 142:510–524PubMedGoogle Scholar
  12. 12.
    De Vriese AS, Bourgeois M (2003) Pharmacologic treatment of acute renal failure in sepsis. Curr Opin Crit Care 9:474–480PubMedCrossRefGoogle Scholar
  13. 13.
    Patel BM, Chittock DR, Russell JA, Walley KR (2002) Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 96:576–582PubMedCrossRefGoogle Scholar
  14. 14.
    Sladen RN, Landry D (2000) Renal blood flow regulation, autoregulation, and vasomotor nephropathy. Anesthesiol Clin North America 18:791–807PubMedCrossRefGoogle Scholar
  15. 15.
    Yamaguchi N, Jesmin S, Zaedi S, Shimojo N, Maeda S, Gando S, Koyama A, Miyauchi T (2006) Time-dependent expression of renal vaso-regulatory molecules in LPS-induced endotoxemia in rat. Peptides 27:2258–2270PubMedCrossRefGoogle Scholar
  16. 16.
    Wan L, Bellomo R, Giantomasso D di, Ronco C (2003) The pathogenesis of septic acute renal failure. Curr Opin Crit Care 9:496–502PubMedCrossRefGoogle Scholar
  17. 17.
    Giantomasso D di, Morimatsu H, May CN, Bellomo R (2003) Intrarenal blood flow distribution in hyperdynamic septic shock: effect of norepinephrine. Crit Care Med 31:2509–2513CrossRefGoogle Scholar
  18. 18.
    Yasuda H, Yuen PS, Hu X, Zhou H, Star RA (2006) Simvastatin improves sepsis-induced mortality and acute kidney injury via renal vascular effects. Kidney Int 69:1535–1542PubMedCrossRefGoogle Scholar
  19. 19.
    Wu L, Tiwari MM, Messer KJ, Holthoff JH, Gokden N, Brock RW, Mayeux PR (2007) Peritubular capillary dysfunction and renal tubular epithelial cell stress following lipopolysaccharide administration in mice. Am J Physiol Renal Physiol 292:F261–F268PubMedCrossRefGoogle Scholar
  20. 20.
    Gupta A, Rhodes GJ, Berg DT, Gerlitz B, Molitoris BA, Grinnell BW (2007) Activated protein C ameliorates LPS-induced acute kidney injury and down-regulates renal iNOS and Angiotensin 2. Am J Physiol Renal Physiol 0:00477.2006v1Google Scholar
  21. 21.
    Rosenberger C, Rosen S, Heyman SN (2006) Renal parenchymal oxygenation and hypoxia adaptation in acute kidney injury. Clin Exp Pharmacol Physiol 33:980–988PubMedCrossRefGoogle Scholar
  22. 22.
    Thurau K, Boylan JW (1976) Acute renal success. The unexpected logic of oliguria in acute renal failure. Am J Med 61:308–315PubMedCrossRefGoogle Scholar
  23. 23.
    Singer M, Santis V de, Vitale D, Jeffcoate W (2004) Multiorgan failure is an adaptive, endocrine-mediated, metabolic response to overwhelming systemic inflammation. Lancet 364:545–548PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Martin Matejovic
    • 1
  • Peter Radermacher
    • 2
  • Michael Joannidis
    • 3
  1. 1.First Medical DepartmentCharles University Medical School and Teaching HospitalPlzenCzech Republic
  2. 2.Sektion Anästhesiologische Pathophysiologie und VerfahrensentwicklungUniversitätsklinikum UlmUlmGermany
  3. 3.Department of General Internal Medicine, Medical ICUMedical University InnsbruckInnsbruckAustria

Personalised recommendations