Nephrology and Endocrinology, Hemodialysis and Apheresis, University Hospital, The University of Tokyo, Tokyo, Japan.
Clin Exp Nephrol. 2011 Aug;15(4):464-70. doi: 10.1007/s10157-011-0459-4. Epub 2011 Jun 1.
The mortality of acute kidney injury (AKI) remains unacceptably high, especially associated with acute respiratory failure. Lung injury complicated with AKI was previously considered as "uremic lung", which is characterized by volume overload and increased vascular permeability. New experimental data using rodent models of renal ischemia-reperfusion and bilateral nephrectomy have emerged recently focusing on kidney-lung crosstalk in AKI, and have highlighted the pathophysiological significance of increased cytokine concentration, enhanced inflammatory responses, and neutrophil activation. In this review, we outline the history of uremic lung and acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), the epidemiological data on the synergistic effect of AKI and lung injury on mortality, and recent basic research which has identified possible pathways in AKI-induced lung injury. These findings will enable us to develop new therapeutic strategies against lung injury associated with AKI and improve the outcomes of critically ill patients in intensive care units.
急性肾损伤 (AKI) 的死亡率仍然高得令人无法接受，尤其是与急性呼吸衰竭相关。以前，与 AKI 相关的肺损伤被认为是“尿毒症肺”，其特征是容量超负荷和血管通透性增加。最近，使用肾缺血再灌注和双侧肾切除术的啮齿动物模型的新实验数据集中于 AKI 中的肾-肺相互作用，并强调了细胞因子浓度增加、炎症反应增强和中性粒细胞激活的病理生理意义。在这篇综述中，我们概述了尿毒症肺和急性肺损伤 (ALI)/急性呼吸窘迫综合征 (ARDS) 的历史，AKI 和肺损伤对死亡率的协同作用的流行病学数据，以及最近确定 AKI 诱导的肺损伤中可能途径的基础研究。这些发现将使我们能够针对与 AKI 相关的肺损伤开发新的治疗策略，并改善重症监护病房中危重病患者的预后。
