Mendes Renata de Souza, Silva Pedro Leme, Robba Chiara, Battaglini Denise, Lopes-Pacheco Miquéias, Caruso-Neves Celso, Rocco Patricia R M
Department of Nephrology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Department of Nephrology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Intensive Care Med Exp. 2024 Sep 16;12(1):81. doi: 10.1186/s40635-024-00672-1.
This narrative review delves into the intricate interplay between the lungs and the kidneys, with a focus on elucidating the pathogenesis of diseases influenced by immunological factors, acid-base regulation, and blood gas disturbances, as well as assessing the effects of various therapeutic modalities on these interactions. Key disorders, such as anti-glomerular basement membrane (anti-GBM) disease, the syndrome of inappropriate antidiuretic hormone secretion (SIADH), and Anti-neutrophil Cytoplasmic Antibodies (ANCA) associated vasculitis (AAV), are also examined to shed light on their underlying mechanisms. This review also explores the relationship between acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), emphasizing how inflammatory mediators can lead to systemic damage and impact multiple organs. In ARDS, fluid overload exacerbates pulmonary edema, while imbalances in blood volume, such as hypovolemia or hypervolemia, can precipitate renal dysfunction. The review highlights how mechanical ventilation strategies can compromise renal blood flow, trigger systemic inflammation, and induce hemodynamic and neurohormonal alterations, all contributing to lung and kidney damage. The impact of extracorporeal membrane oxygenation (ECMO) on lung-kidney interactions is evaluated, highlighting its role in severe respiratory failure and its renal implications. Emerging therapies, such as mesenchymal stem cells and extracellular vesicles, are discussed as promising avenues to mitigate organ damage and enhance outcomes in critically ill patients. Overall, this review offers a nuanced exploration of lung-kidney dynamics, bridging historical insights with contemporary perspectives. It underscores the clinical significance of these interactions in critically ill patients and advocates for integrated management approaches to optimize patient outcomes.
本叙述性综述深入探讨了肺与肾之间复杂的相互作用，重点阐述受免疫因素、酸碱调节和血气紊乱影响的疾病的发病机制，以及评估各种治疗方式对这些相互作用的影响。还对关键疾病，如抗肾小球基底膜（anti-GBM）病、抗利尿激素分泌不当综合征（SIADH）和抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）进行了研究，以阐明其潜在机制。本综述还探讨了急性呼吸窘迫综合征（ARDS）与急性肾损伤（AKI）之间的关系，强调炎症介质如何导致全身损伤并影响多个器官。在ARDS中，液体超负荷会加重肺水肿，而血容量失衡，如低血容量或高血容量，可引发肾功能障碍。该综述强调了机械通气策略如何损害肾血流、引发全身炎症并诱导血流动力学和神经激素改变，所有这些都会导致肺和肾损伤。评估了体外膜肺氧合（ECMO）对肺-肾相互作用的影响，突出了其在严重呼吸衰竭中的作用及其对肾脏的影响。讨论了间充质干细胞和细胞外囊泡等新兴疗法，认为它们是减轻器官损伤和改善危重症患者预后的有前景的途径。总体而言，本综述对肺-肾动态进行了细致入微的探索，将历史见解与当代观点联系起来。它强调了这些相互作用在危重症患者中的临床意义，并倡导采用综合管理方法以优化患者预后。
