Abstract
This article reviews current knowledge as to the physiological mechanisms that control renal vascular resistence. The contribution of both extrinsic and intrinsic neuro-humoral regulation of both blood flow and glomerular filtration rate are described. The changes that occur both to the renal blood flow and glomerular filtration rate in the pathophysiological situation of “pre-renal uraemia” as well as “acute tubular necrosis” are described. Within this setting pharmacological manoeuvres that may improve both renal blood flow and glomerular filtration rate are discussed. In addition, the indications for and general principles of haemo- and peritoneal dialysis are described.
Similar content being viewed by others
References
Aukland, K.: Vasopressin and intra-renal blood distribution. Acta. physiol. scand. 74, 173 (1968)
Aukland, K.: Effective adrenalin, noradrenalin, angiotensin and renal nerve stimulation on intra-renal distribution of blood flow in dogs. Acta physiol. scand. 72, 498 (1968)
Aukland, K., Berliner, R. W.: Renal medullary countercurrent system studied with hydrogen gas. Circulat. Res. 15, 430 (1964)
Barger, A. C.: Renal haemodynamics factors in congestive heart failure. Ann. N. Y. Acad. Sci. 139, 276 (1960)
Barry, K. G., Cohen, A., Knochel, J. P., Whelan, T. J., Beisel, W. R., Vargas, C. A., LeBlanc, P. C.: Mannitol infusion II: The prevention of acute functional renal failure in resection of an aneurysm of the abdominal aorta. New Engl. J. Med. 264, 967 (1961)
Bell, G., Lister, G. D.: The effect of noradrenaline and haemoxybenzamine on the renal response to haemorrhage. Surg. Gynec. Obstet. 130, 813 (1970)
Berman, L. B., Omen, K., Chisholm, G.: Unilateral renal haemodynamic changes with hypertonic mannitol. Proc. Soc. exp. Biol. (N.Y.) 113, 949 (1963)
Birtch, A. G., Zakheim, R. M., Jones, L. G., Barger, A. C.: Redistribution of renal blood flow produced by furosemide and ethacrynic acid. Circulat. Res. 21, 869 (1967)
Blantz, R. C.: Mechanism of acute renal failure (ARF) after uranylnitrate (UN) (abstract). Clin. Res. 22, 517 A (1974)
Boylan, J. W., Asshauer, E.: Depletion and restoration of the medullary osmotic gradient in the dog kidney. Pflügers Arch. ges. Physiol. 276, 99 (1962)
Borst, M.: Pathologische-anatomische Erfahrungen über Kriegsverletzungen. Samml. klin. Vortr. 735, 297 (1917)
Brain, W. E., Lilienfield, L. S.: Renal haemodynamic effects of hypertonic mannitol infusions. Proc. Soc. exp. Biol (N. Y.) 114, 1 (1963)
Brown, C. B., Ogg, C. S., Cameron, J. S., Bewick, M.: High dose frusemide in acute reversible intrinsic renal failure. Scot. Med. J. Suppl. 1, 19, 35 (1974).
Burger, B. M., Hopkins, T., Tullock, A., Hollenberg, N. K.: The role of angiotensin in the canine renal vasculature response to barbiturate anaesthesia. Circulat. Res. 38, 196 (1976)
Cantarovich, F., Galli, C., Benedetti, L., Chena, C., Castro, L., Correa, C., Perez Loredo, J., Fernandez, T. C., Locatelli, A., Tizado, J.: High dose frusemide in established acute renal failure. Brit. med. J. iv, 449 (1973)
Carriere, S., Fribourg, J.: Intra-renal blood flow and P.A.H. extraction during angiotensin infusion. Amer. J. Physiol. 217, 1708 (1969)
Carriere, S.: Effective norepinephrin, isoproterenol, and adrenergic blockers upon the intra-renal distribution of blood flow. Canad. J. Physiol. Pharmacol. 47, 199 (1969)
Carriere, S., Thorburn, G. D., O'Morchoe, C. C., Barger, A. C.: Intrarenal distribution of blood flow in dogs during haemorrhagic hypotension. Circulat. Res. 19, 167 (1966)
Charbon, G. A., Reneman, R. S.: The effects of beta receptor agonists and antagonists on regional blood flow. Europ. J. Pharmacol. 9, 21 (1970)
Clarkson, A. R., MacDonald, M. K., Fuster, E., Cash, J. D., Robson, J. S.: Glomerular coagulation in acute ischaemic renal failure. Quart. J. Med. 34, 585 (1970)
Coelho, A. B., Bradley, S. E.: Function of the nephron population during haemorrhagic hypotension in dogs, with special reference to the effects of osmotic diuresis. J. clin. Invest. 43, 386 (1964)
Corcoran, A. C., Kohlstaedt, K. G., Page, I. H.: Changes of arterial blood pressure and renal haemodynamics by injection of angiotensin in human beings. Proc. Soc. exp. biol. (N.Y.) 46, 244 (1941)
Ducharm, D. W., Beck, L.: The relative effect of the renal pressor and sympathetic nervous system in vascular capacity during hypotension. J. Pharmacol. exp. Ther. 177, 56 (1971)
Feldberg, W., Lewis, G. P.: The action of peptides on the adrenal medulla. Release of adrenalin by bradykinin and angiotensin. J. Physiol. 171, 98 (1964)
Flanigan, W. J., Oken, D. E.: Renal micropuncture study of the development of anuria in the rat with mercury-induced acute renal failure. J. clin. Invest. 44, 482 (1965)
Flohr, H.: Regional distribution of blood flow in the renal cortex. Experientia 25, 779 (1969)
Flores, J., Dibona, D. R., Beck, C. H., Leaf, A.: The role of cell swelling in ischaemia renal damage and the protective effect of hypertonic solute. J. clin. Invest. 51, 118 (1972)
Goldberg, L. I.: Dopamine — Clinical uses of an endogenous catecholamine. New Engl. J. Med. 291, 707 (1974)
Goormaghtigh, N.: La fonction endocrine des arterioles renales. Rev. belge Sci. med. 16, 65 (1945)
Goormaghtigh, N.: (1) La doctrine de la cellulet masculair, afibrillair, endocrine en pathologie humane. (2) La rein de l'eclampsie puerperale. Bull. Acad. roy. Med. (Belg.) 7, 194 (1942)
Goormaghtigh, N.: Vascular and circulatory changes in the anuric renal cortex crush syndrome. Proc. Soc. exp. Biol. 59, 303 (1945)
Goormaghtigh, N.: The renal arteriolar changes in the anuric crush syndrome. Amer. J. Path. 23, 513 (1947)
Hackradt, A.: Über akute, tödliche vasomatorische Nephrosen nach Verschüttung. Inaugural Dissertation, Munich 1917
Hardaway, R. M.: Clinical management of shock: surgical and medical. Springfield: Thomas 1968
Harvey, R. B.: Effects of acetylcholine infused into the renal artery in dogs. Amer. J. Physiol. 211, 487 (1966)
Hollenberg, M. K., Epstein, M., Guttmann, R. D.: Effect of sodium balance on inter-renal distribution of blood flow in normal man. J. appl. Physiol. 28, 312 (1970)
Hollenberg, N. K., Epstein, M., Rosen, S. M., Basch, R. I., Oken, D. E., Merrill, J. P.: Acute oliguric renal failure in man: evidence for preferential renal cortical ischaemia. Medicine (Baltimore) 47, 455 (1968)
Hollenberg, N. K.: The role of the sympathetic nervous system in the development of decompensation during haemorhagic shock. Doctoral Thesis, University of Manitoba Press (1965)
Ishikawa, I., Hollenberg, N. K.: Pharmacologic interruption of the renin-angiotensin system in myohaemoglobinuric acute renal failure. 1976 in press
Jakschick, B. A., Macknight, R. C., Marshall, T. R., Feldhaus, R. A., Needleman, T.: Renal vascular changes during haemorrhagic shock and the pharmacologic modification by angiotensin and catecholamine antagonists. Circulat. Shock 1, 231 (1974)
Jakschick, B. A., Marshall, T. R., Kourick, J. L., Needleman, T.: Profile of circulating vasoactive substances in haemorrhagic shock and the pharmacologic manipulation. J. clin. Invest. 54, 842 (1974)
Kennedy, A. C., Burton, J. A., Luke, R. G., Briggs, R. G., Lindsay, R. M., Alison, M. E. M., Edward, N., Dargie, K. J.: Factors affecting the prognosis in acute renal failure. A survey of 251 cases. Quart. J. Med. 42, 73 (1972)
Kiil, F., Kjekshus, J., Loyning, E.: Renal autoregulation during infusion of noradrenalin, angiotensin and acetylcholine. Acta physiol. scand. 76, 10 (1969)
Kleinknecht, D., Ganeval, G., Gonzales-Duque, L. A., Germanian, J.: Frusemide in acute oliguric renal failure. A controlled trial. Nephron 17, 51 (1976)
Lee, J. B.: Prostaglandins. Physiologist 13, 379 (1970)
Ludens, J. H., Williamson, H. E.: Effect of furosemide on renal blood flow in the conscious dog. Proc. Soc. exp. Biol. 154, 513 (1970)
McKenna, O. C., Angelakos, E. T.: Adrenergic innovation of the canine kidney. Circulat. Res. 22, 345 (1968)
Motsay, G. J., Alhoa, A., Jaeger, T., Dietzman, R. H., Lillehie, R. C.: Effects of corticosteroids on the circulation in shock: experimental and clinical results. Fed. Proc. 29, 1861 (1970)
Murphy, D. P., Gatmon, J. A., Ewald, R. A.: Renal and systemic haemodynamic effects of dibenzaline in normotension and haemorrhagic hypertension. Surgery 57, 856 (1965)
Needleman, T., Marshal, G. R., Johnson, E. M.: Determinants and modification of adrenergic and vascular resistance in the kidney. Amer. J. Physiol. 227, 665 (1974)
Nickerson, M.: Shock: pathogenesis and therapy (Ed. K. D. Bock). Berlin, Heidelberg, New York: Springer 1962
Oken, D. E.: An over-view of the pathophysiology of the vasomotor nephropathy in acute renal failure (Ed. Friedman & Eliahou). D. H. E. W. Publication No. (NIH) 74/608, 89 (1973)
Pelroth, M. G., Harrison, D. C.: Cardiogenic shock review. Clin. Pharmacol. Ther. 10, 449 (1969)
Peters, G., Brunner, H.: Manniton diuresis in haemorrhagic hypertension. Amer. J. Physiol. 204, 555 (1963)
Pomeranz, B. H., Birtch, A. G., Barger, A. C.: Neural control of intra-renal blood flow. Amer. J. Physiol. 215, 1067 (1968)
Powers, S. R., Boba, A., Hostnik, W., Stein, A.: Prevention of post-operative acute renal failure with mannitol in 100 cases. Surgery 55, 15 (1964)
Richards, D. W.: Homeostasis versus Hyperexis: or St. George and the Dragon. Sci. monthly 71, 289 (1953)
Rosen, S. M., Hollenberg, N. K., Dealy, J. B., Merrill, J. P.: Measurement of the distribution of blood flow in the human kidney using the intra-arterial injection of133Xe. Relationship to function in the normal and transplanted kidney. Clin. Sci. 34, 287 (1968)
Shumer, W., Nyhus, W. M.: Corticosteroids in the treatment of shock. Urbana: University of Illinois Press 1970
Stahl, W. M., Stone, A. M.: Prophylactic diuresis with ethacrynic acid for prevention of postoperative renal failure. Annal. Surg. 172, 361 (1970)
Stein, J. H., Gottschall, J., Osgood, R. W., Ferris, T. F.: Pathophysiology of a nephrotic model of acute renal failure. Kid. Int. 8, 27 (1975)
Thorburn, G. D., Copald, H. H., Herd, J. A., Hollenberg, M., O'Morchoe, C. C. C., Barger, A. C.: Intra-renal distribution of nutrient blood flow determined with85Krypton in the unanaesthetised dog. Circulat. Res. 13, 290 (1963)
Thurau, K.: Renal haemodynamics. Amer. J. Med. 36, 698 (1964)
Trueta, J., Barclay, A. E., Daniel, P. M., Frankland, K. J., Pritchard, M. M. L.: Studies of the renal circulation. Springfield: Thomas 1947
Weitsten, J., Norvell, J. E.: Cholinergic innovation of the auto-transplanted canine kidney. Circulat. Res. 25, 535 (1969)
Wendling, M. G., Eckstein, J. W., Upwood, S. M.: Effects of mannitol on renal circulation. J. Lab. clin. Med. 74, 541 (1969)
Acute Renal Failure. Editorial. Lancet 11, 134 (1973)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Brown, C.B. Shock and the kidney: Pathophysiology and pharmacological support. Intensive Care Med 3, 1–13 (1977). https://doi.org/10.1007/BF01683183
Issue Date:
DOI: https://doi.org/10.1007/BF01683183