Abstract
The kidney is, if not the forgotten organ, then perhaps the least investigated in the critically ill patient. However, other than offering the patient the best intensive care management possible, with appropriate maintenance of pressure and flow through judicious use of fluids and vasoactive drug support, there is no specific treatment available to reverse kidney dysfunction [1]. The introduction of biocompatible membranes has made renal replacement therapy (RRT) an easy, safe and routine procedure on most ICUs. Except in cases of deliberate treatment withdrawal, death from acute renal failure is now very rare. Acute renal failure is thus often regarded as a relatively minor, easily supported distraction, compared with the weightier cardiorespiratory problems that preoccupy the intensivist.
Keywords
Nitric Oxide Acute Renal Failure Renal Replacement Therapy Renal Blood Flow Acute Tubular NecrosisPreview
Unable to display preview. Download preview PDF.
References
- 1.O’Leary MJ, Bihari DJ (2001) Preventing renal failure in the critically ill. There are no magic bullets-just high quality intensive care. Br Med J 322: 1437–1439Google Scholar
- 2.Rangel-Frausto MS, Pittet D, Costigan M, et al (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273: 117–123Google Scholar
- 3.Levy EM, Viscoli CM, Horwitz RI (1996) The effect of acute renal failure on mortality. A cohort analysis. JAMA 275: 1489–1494Google Scholar
- 4.Noble JS, MacKirdy FN, Donaldson SI, Howie JC (2001) Renal and respiratory failure in Scottish ICUs. Anaesthesia 56: 124–129PubMedCrossRefGoogle Scholar
- 5.de Mendonca A,Vincent JL, Suter PM, et al (2000) Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 26: 915–921PubMedCrossRefGoogle Scholar
- 6.Sweet SJ, Glenney CU, Fitzgibbons JP, Friedmann P, Teres D (1981) Synergistic effect of acute renal failure and respiratory failure in the surgical intensive care unit. Am J Surg 141: 492–496PubMedCrossRefGoogle Scholar
- 7.Brezis M, Agmon Y, Epstein FH (1994) Determinants of intrarenal oxygenation. I. Effects of diuretics. Am J Physiol 267: F1059–F1062PubMedGoogle Scholar
- 8.Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J (2000) Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society ( ANZICS) Clinical Trials Group. Lancet 356: 21392143Google Scholar
- 9.Galley HF (2000) Renal-dose dopamine: will the message now get through? Lancet 356: 2112–2113PubMedCrossRefGoogle Scholar
- 10.Thurau K, Boylan JW (1976) Acute renal success. The unexpected logic of oliguria in acute renal failure. Am J Med 61: 308–315Google Scholar
- 11.Thijs A, Thijs LG (1998) Pathogenesis of renal failure in sepsis. Kidney Int Suppl 66: S34–S37PubMedGoogle Scholar
- 12.Hotchkiss RS, Swanson PE, Freeman BD, et al (1999) Apoptotic cell death in patients with sepsis shock and multiple organ dysfunction. Crit Care Med 27: 1230–1251PubMedCrossRefGoogle Scholar
- 13.Richman AV, Okulski EG, Balis JU (1981) New Concepts in the pathogenesis of acute tubular necrosis associated with sepsis. Ann Clin Lab Sci 11: 211–219PubMedGoogle Scholar
- 14.Finckh ES, Jeremy D, Whyte HM (1962) Structural renal damage and its relation to clinical features in oliguric renal failure. Q J Med 31: 429–446PubMedGoogle Scholar
- 15.Brun C, Munk O (1957) Lesions of the kidney in acute renal failure following shock. Lancet 1: 603–609CrossRefGoogle Scholar
- 16.Olsen TS, Olsen HS, Hansen HE (1985) Tubular ultrastructure in acute renal failure in man: epithelial necrosis and regeneration Virchows. Arch A Pathol Anat Histopathol 406: 75–89CrossRefGoogle Scholar
- 17.Brezis M, Rosen S (1995) Hypoxia of the renal medulla - its implications for disease. N Engl J Med 332: 647–655PubMedCrossRefGoogle Scholar
- 18.Camacho MT, Totapally BR, Torbati D, Wolfsdorf J (2001) Pulmonary and extrapulmonary effects of increased colloid osmotic pressure during endotoxemia in rats. Chest 120: 1655–1662PubMedCrossRefGoogle Scholar
- 19.Brezis M, Heyman SN, Epstein FH (1994) Determinants of intrarenal oxygenation. II. Hemodynamic effects. Am J Physiol 267: F1063–F1068PubMedGoogle Scholar
- 20.Heyman SN, Darmon D, Goldfarb M, et al (2000) Endotoxin-induced renal failure. i. A role for altered renal microcirculation. Exp Nephrol 8: 266–274Google Scholar
- 21.James PE, Bacic G, Grinberg OY, et al (1996) Endotoxin-induced changes in intrarenal P02 measured by in vivo electron paramagnetic resonance oximetry and magnetic resonance imaging. Free Radic Biol Med 21: 25–34PubMedCrossRefGoogle Scholar
- 22.Holmes CL, Patel BM, Russell JA, Walley KR (2001) Physiology of vasopressin relevant to management of septic shock. Chest 120: 989–1002PubMedCrossRefGoogle Scholar
- 23.Khan RZ, Badr KF (1999) Endotoxin and renal function: perspectives to the understanding of septic acute renal failure and toxic shock. Nephrol Dial Transplant 14: 814–818PubMedCrossRefGoogle Scholar
- 24.Ravikant T, Lucas CE (1977) Renal blood flow distribution in septic hyperdynamic pigs. J Surg Res 22: 294–298PubMedCrossRefGoogle Scholar
- 25.Cronenwett JL, Lindenauer SM (1978) Distribution of intrarenal blood flow during bacterial sepsis. J Surg Res 24: 132–141PubMedCrossRefGoogle Scholar
- 26.Liss P, Nygren A, Revsbech NP, Ulfendahl HR (1997) Intrarenal oxygen tension measured by a modified clark electrode at normal and low blood pressure and after injection of x-ray contrast media. Pflugers Arch 434: 705–711PubMedCrossRefGoogle Scholar
- 27.Leichtweiss HP, Lubbers DW, Weiss C, Baumgartl H, Reschke W (1969) The oxygen supply of the rat kidney: measurements of intrarenal PO2. Pflugers Arch 309: 328–349PubMedCrossRefGoogle Scholar
- 28.Lubbers DW, Baumgartl H (1997) Heterogeneities and profiles of oxygen pressure in brain and kidney as examples of the PO2 distribution in the living tissue. Kidney Int 51: 372–380PubMedCrossRefGoogle Scholar
- 29.Heyman SN, Rosen S, Epstein FH, Spokes K, Brezis ML (1994) Loop diuretics reduce hypoxic damage to proximal tubules of the isolated perfused rat kidney. Kidney Int 45: 981–985PubMedCrossRefGoogle Scholar
- 30.Epstein FH, Prasad P (2000) Effects of furosemide on medullary oxygenation in younger and older subjects. Kidney Int 57: 2080–2083PubMedCrossRefGoogle Scholar
- 31.James PE, Jackson SK, Grinberg OY, Swartz HM (1995) The effects of endotoxin on oxygen consumption of various cell types in vitro: an EPR oximetry study. Free Radic Biol Med 18: 641–647PubMedCrossRefGoogle Scholar
- 32.Koivisto A, Pittner J, Froelich M, Persson AE (1999) Oxygen-dependent inhibition of respiration in isolated renal tubules by nitric oxide. Kidney Int 55: 2368–2375PubMedCrossRefGoogle Scholar
- 33.Seeliger E, Persson PB, Boemke W, et al (2001) Low-dose nitric oxide inhibition produces a negative sodium balance in conscious dogs. J Am Soc Nephrol 12: 1128–1136PubMedGoogle Scholar
- 34.Millar CG, Thiemermann C (1997) Intrarenal haemodynamics and renal dysfunction in endotoxaemia: effects of nitric oxide synthase inhibition. Br J Pharmacol 121: 1824–1830PubMedCrossRefGoogle Scholar
- 35.Bachmann S, Bosse HM, Mundel P (1995) Topography of nitric oxide synthesis by localizing constitutive NO synthases in mammalian kidney. Am J Physiol 268: F885–F898PubMedGoogle Scholar
- 36.Schwartz D, Brasowski E, Raskin Y, et al (2001) The outcome of non-selective vs selective nitric oxide synthase inhibition in lipopolysaccharide treated rats. J Nephrol 14: 110–114PubMedGoogle Scholar
- 37.Wray GM, Millar CG, Hinds CJ, Thiemermann C (1998) Selective inhibition of the activity of inducible nitric oxide synthase prevents the circulatory failure but not the organ injury/ dysfunction caused by endotoxin. Shock 9: 329–335PubMedCrossRefGoogle Scholar
- 38.Brown GC (2000) Nitric oxide as a competitive inhibitor of oxygen consumption in the mitochondrial respiratory chain. Acta Physiol Scand 168: 667–674PubMedCrossRefGoogle Scholar
- 39.Beltran B, Mathur A, Duchen MR, Erusalimsky JD, Moncada S (2000) The effect of nitric oxide on cell respiration: A key to understanding its role in cell survival or death. Proc Natl Acad Sci USA 97: 14602–14607Google Scholar
- 40.Singer M, Brealey D (1999) Mitochondrial dysfunction in sepsis. In: Brown GC, Nicholls DG, Cooper CE (eds) Mitochondria and Cell Death-Biochemical Society Symposium. Portland Press, London, pp 149–166Google Scholar
- 41.Asher EF, Garrison RN, Ratcliffe DJ, Fry DE (1983) Endotoxin cellular function and nutrient blood flow. Arch Surg 118: 441–445PubMedCrossRefGoogle Scholar
- 42.Garrison RN, Ratcliffe DJ, Fry DE (1982) The effects of peritonitis on murine renal mitochondria. Adv Shock Res 7: 71–76PubMedGoogle Scholar
- 43.Mela L (1981) Direct and indirect effects of endotoxin on mitochondrial function. Prog Clin Biol Res 62: 15–21PubMedGoogle Scholar
- 44.Mela L, Miller LD (1983) Efficacy of glucocorticoids in preventing mitochondrial metabolic failure in endotoxemia. Circ Shock 10: 371–381PubMedGoogle Scholar