Singbartl Kai
Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa., USA.
Contrib Nephrol. 2011;174:65-70. doi: 10.1159/000329237. Epub 2011 Sep 9.
Acute kidney injury (AKI) remains a major clinical challenge, especially in combination with acute lung injury (ALI). Clinical as well as experimental studies have provided evidence for clinically relevant kidney-lung interactions, ultimately leading to a drastic reduction in survival. The crosstalk between AKI and ALI is a consequence of both direct loss of normal organ function and inflammatory dysregulation resulting from each organ failure. Cellular (e.g. neutrophils) as well as soluble mediators (cytokines) contribute to the inflammatory dysregulation under these circumstances. Clinical interventions are currently limited to general, unspecific preventive or supportive measures. With respect to AKI, these strategies include adequate volume control, correction of acid-base/electrolyte abnormalities and elimination of uremic substances by renal replacement therapy. Lung protective ventilation, including low tidal volume ventilation, is a cornerstone in the management of ALI. This approach has been shown to attenuate both the direct mechanical effects of ventilation and the inflammatory response arising from ALI and mechanical ventilation, ultimately reducing the incidence of extrapulmonary organ failure. The fact that multiorgan failure is not only the sum of organ functions lost, but also includes inflammatory dysregulation together with a lack of treatment options greatly emphasizes the need for future research in this area.
急性肾损伤（AKI）仍然是一项重大的临床挑战，尤其是在合并急性肺损伤（ALI）时。临床研究和实验研究均已为临床上相关的肾-肺相互作用提供了证据，这最终导致生存率大幅降低。AKI与ALI之间的相互作用是正常器官功能直接丧失以及各器官功能衰竭导致的炎症失调共同作用的结果。在这种情况下，细胞（如中性粒细胞）以及可溶性介质（细胞因子）均会导致炎症失调。目前临床干预措施仅限于一般的、非特异性的预防或支持措施。对于AKI，这些策略包括适当的容量控制、纠正酸碱/电解质异常以及通过肾脏替代疗法清除尿毒症物质。肺保护性通气，包括低潮气量通气，是ALI管理的基石。这种方法已被证明可减轻通气的直接机械效应以及ALI和机械通气引起的炎症反应，最终降低肺外器官衰竭的发生率。多器官功能衰竭不仅是器官功能丧失的总和，还包括炎症失调以及缺乏治疗选择，这一事实极大地凸显了该领域未来研究的必要性。
