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Best Pract Res Clin Anaesthesiol. 2017 Sep;31(3):315-329. doi: 10.1016/j.bpa.2017.10.002. Epub 2017 Nov 2.

The macro- and microcirculation of the kidney.

Author information

1
Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, France; INSERM U1116, University of Lorraine, Vandoeuvre-Les-Nancy, France; Department of Translational Physiology, Academic Medical Centre, Amsterdam, The Netherlands.
2
Department of Translational Physiology, Academic Medical Centre, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
3
Department of Translational Physiology, Academic Medical Centre, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. Electronic address: c.ince@amc.uva.nl.

Abstract

Acute kidney injury (AKI) remains one of the main causes of morbidity and mortality in the intensive care medicine today. Its pathophysiology and progress to chronic kidney disease is still under investigation. In addition, the lack of techniques to adequately monitor renal function and microcirculation at the bedside makes its therapeutic resolution challenging. In this article, we review current concepts related to renal hemodynamics compromise as being the event underlying AKI. In doing so, we discuss the physiology of the renal circulation and the effects of alterations in systemic hemodynamics that lead to renal injury specifically in the context of reperfusion injury and sepsis. The ultimate key culprit of AKI leading to failure is the dysfunction of the renal microcirculation. The cellular and subcellular components of the renal microcirculation are discussed and how their injury contributes to AKI is described.

KEYWORDS:

acute kidney injury; hemodynamic coherence; microcirculation; renal blood flow; renal tissue oxygenation

PMID:
29248139
DOI:
10.1016/j.bpa.2017.10.002
[Indexed for MEDLINE]

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