Visconti Luca, Santoro Domenico, Cernaro Valeria, Buemi Michele, Lacquaniti Antonio
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
J Nephrol. 2016 Jun;29(3):341-348. doi: 10.1007/s40620-016-0276-7. Epub 2016 Mar 3.
Lung and kidney functions are intimately related in both health and disease. The regulation of acid-base equilibrium, modification of partial pressure of carbon dioxide and bicarbonate concentration, and the control of blood pressure and fluid homeostasis all closely depend on renal and pulmonary activities. These interactions begin in fetal age and are often responsible for the genesis and progression of diseases. In gestational age, urine is a fundamental component of the amniotic fluid, acting on pulmonary maturation and growth. Moreover, in the first trimester of pregnancy, kidney is the main source of proline, contributing to collagen synthesis and lung parenchyma maturation. Pathologically speaking, the kidneys could become damaged by mediators of inflammation or immuno-mediated factors related to a primary lung pathology or, on the contrary, it could be the renal disease that determines a consecutive pulmonary damage. Furthermore, non immunological mechanisms are frequently involved in renal and pulmonary diseases, as observed in chronic pathologies such as sleep apnea syndrome, pulmonary hypertension, progressive renal disease and hemodialysis. Kidney damage has also been related to mechanical ventilation. The aim of this review is to describe pulmonary-renal interactions and their related pathologies, underscoring the need for a close collaboration between intensivists, pneumologists and nephrologists.
肺和肾的功能在健康和疾病状态下都密切相关。酸碱平衡的调节、二氧化碳分压和碳酸氢盐浓度的改变以及血压和液体稳态的控制都紧密依赖于肾脏和肺部的活动。这些相互作用始于胎儿期，且常常是疾病发生和进展的原因。在妊娠期，尿液是羊水的基本组成部分，对肺的成熟和生长起作用。此外，在妊娠早期，肾脏是脯氨酸的主要来源，有助于胶原蛋白合成和肺实质成熟。从病理学角度来看，肾脏可能会因与原发性肺部疾病相关的炎症介质或免疫介导因素而受损，或者相反，肾脏疾病可能会导致继发性肺部损伤。此外，非免疫机制也经常参与肾脏和肺部疾病，如在睡眠呼吸暂停综合征、肺动脉高压、进行性肾脏疾病和血液透析等慢性疾病中所见。肾脏损伤也与机械通气有关。本综述的目的是描述肺肾相互作用及其相关病理，强调重症监护医生、呼吸科医生和肾病科医生密切合作的必要性。
