1 Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy.
2 Division of Pulmonology, Nephrology and Critical Care Medicine, Department of Internal Medicine II, University Clinic Giessen and Marburg-Campus Giessen, Giessen, Germany.
Am J Respir Crit Care Med. 2016 Aug 15;194(4):402-14. doi: 10.1164/rccm.201602-0420CP.
Discoveries have emerged highlighting the complex nature of the interorgan cross-talk between the kidney and the lung. Vascular rigidity, neurohormonal activation, tissue hypoxia, and abnormal immune cell signaling have been identified as common pathways leading to the development and progression of chronic kidney disease. However, our understanding of the causal relationships between lung injury and kidney injury is not precise. This review discusses a number of features and mechanisms of renal dysfunction in pulmonary disorders in relation to respiratory acidosis, impaired gas exchange, systemic congestion, respiratory support/replacement therapies, and other issues relevant to the clinical care of these patients. Biotrauma due to injurious ventilatory strategies can lead to the release of mediators into the lung, which may then translocate into the systemic circulation and cause end-organ dysfunction, including renal dysfunction. Right ventricular dysfunction and congestive states may contribute to alterations of renal perfusion and oxygenation, leading to diuretic resistance and recurrent hospitalization. In patients with concomitant respiratory failure, noninvasive ventilation represents a promising treatment option for the correction of impaired renal microcirculation and endothelial dysfunction. In patients requiring extracorporeal membrane oxygenation, short- and long-term monitoring of kidney function is warranted, as they are at highest risk of developing acute kidney injury and fluid overload.
研究发现，肾脏和肺部之间的器官间相互交流具有复杂的性质。血管僵硬、神经激素激活、组织缺氧和异常免疫细胞信号被确定为导致慢性肾脏病发展和进展的共同途径。然而，我们对肺损伤和肾损伤之间因果关系的理解并不准确。本文讨论了与呼吸性酸中毒、气体交换受损、全身淤血、呼吸支持/替代治疗以及与这些患者临床护理相关的其他问题相关的肺部疾病中肾功能障碍的一些特征和机制。由于有创性通气策略引起的生物创伤会导致介质释放到肺部，这些介质可能转移到全身循环并导致终末器官功能障碍，包括肾功能障碍。右心室功能障碍和充血状态可能导致肾灌注和氧合改变，导致利尿剂抵抗和反复住院。对于同时患有呼吸衰竭的患者，无创通气是纠正受损的肾脏微循环和内皮功能障碍的有前途的治疗选择。对于需要体外膜氧合的患者，需要短期和长期监测肾功能，因为他们发生急性肾损伤和液体超负荷的风险最高。
