Institute of Clinical and Experimental Trauma Immunology, University Hospital Ulm, Helmholtzstr. 8/1, 89081, Ulm, Germany.
J Nephrol. 2023 Dec;36(9):2417-2429. doi: 10.1007/s40620-023-01718-5. Epub 2023 Aug 5.
Acute kidney injury development after trauma, burn, or sepsis occurs frequently but remains a scientific and clinical challenge. Whereas the pathophysiological focus has mainly been on hemodynamics and the downstream renal tubular system, little is known about alterations upstream within the glomerulus post trauma or during sepsis. Particularly for the glomerular endothelial cells, mesangial cells, basal membrane, and podocytes, all of which form the glomerular filter, there are numerous in vitro studies on the molecular and functional consequences upon exposure of single cell types to specific damage- or microbial-associated molecular patterns. By contrast, a lack of knowledge exists in the real world regarding the orchestrated inflammatory response of the glomerulus post trauma or burn or during sepsis. Therefore, we aim to provide an overview on the glomerulus as an immune target but also as a perpetrator of the danger response to traumatic and septic conditions, and present major players involved in the context of critical illness. Finally, we highlight research gaps of this rather neglected but worthwhile area to define future molecular targets and therapeutic strategies to prevent or improve the course of AKI after trauma, burn, or sepsis.
创伤、烧伤或脓毒症后急性肾损伤的发生较为常见，但仍然是一个科学和临床挑战。虽然病理生理学的重点主要集中在血液动力学和下游肾小管系统，但对于创伤后或脓毒症期间肾小球内上游的变化知之甚少。特别是对于肾小球内皮细胞、系膜细胞、基底膜和足细胞，所有这些细胞都构成了肾小球滤过器，已经有许多关于单个细胞类型暴露于特定损伤或微生物相关分子模式时的分子和功能变化的体外研究。相比之下，对于创伤后、烧伤后或脓毒症期间肾小球的协调炎症反应，我们在现实世界中知之甚少。因此，我们旨在概述肾小球作为免疫靶点，但也是创伤和脓毒症条件下危险反应的推动者，并介绍其中涉及的主要参与者。最后，我们强调了这一相当被忽视但值得关注的领域的研究空白，以确定预防或改善创伤、烧伤或脓毒症后急性肾损伤的未来分子靶点和治疗策略。
