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Am J Kidney Dis. 2018 Dec;72(6):846-856. doi: 10.1053/j.ajkd.2018.03.028. Epub 2018 Jun 14.

Distant Organ Dysfunction in Acute Kidney Injury: A Review.

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Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Yonsei University College of Medicine, Seoul, South Korea.
Department of Nephrology and Dialysis, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address:


Acute kidney injury (AKI) is common in critically ill patients and is associated with increased morbidity and mortality. Dysfunction of other organs is an important cause of poor outcomes from AKI. Ample clinical and epidemiologic data show that AKI is associated with distant organ dysfunction in lung, heart, brain, and liver. Recent advancements in basic and clinical research have demonstrated physiologic and molecular mechanisms of distant organ interactions in AKI, including leukocyte activation and infiltration, generation of soluble factors such as inflammatory cytokines/chemokines, and endothelial injury. Oxidative stress and production of reactive oxygen species, as well as dysregulation of cell death in distant organs, are also important mechanism of AKI-induced distant organ dysfunction. This review updates recent clinical and experimental findings on organ crosstalk in AKI and highlights potential molecular mechanisms and therapeutic targets to improve clinical outcomes during AKI.


Acute kidney injury (AKI); cardiorenal syndrome (CRS); gut-kidney axis; hepatic dysfunction; lung; microbiota; multi-organ dysfunction; organ crosstalk; reno-cerebral reflex; review

[Available on 2019-12-01]
[Indexed for MEDLINE]

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