The role of the microcirculation in acute kidney injury : Current Opinion in Critical Care (original) (raw)
Renal system: Edited by Ravindra Mehta
Le Dorze, Matthieua,b,*; Legrand, Matthieua,b,*; Payen, Didierb; Ince, Cana
aDepartment of Translational Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
bDepartment of Anesthesiology and Critical Care, Lariboisière Hospital, Assistance Publique – Hôpitaux de Paris, Paris cedex, France
* These authors contributed equally to the paper and should be both considered as first author.
Correspondence to Matthieu Le Dorze, Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands Tel: +31 20 5662140; e-mail: [email protected]
Abstract
Purpose of review
Alterations of the renal microcirculation can promote the development of acute kidney injury through the interlinked occurrence of renal hypoxia and activation of inflammatory pathways. This review focuses on the recent advances in this area, and discusses the possible therapeutic interventions that might be derived from these insights.
Recent findings
Endothelial injury acts as a primary event leading to renal hypoxia with disturbances in nitric oxide pathways playing a major role. The unbalanced homeostasis between nitric oxide, reactive oxygen species and renal oxygenation forms a major component of the microcirculatory dysfunction. Furthermore, injury leads to leukocyte–endothelial interaction that exacerbates renal hypoxia at a microcirculatory level.
Summary
Knowledge of the pathophysiological mechanisms of acute kidney injury emphasizes the importance of the role of the microcirculation in its development. Preventive and therapeutic approach should be based on restoring the homeostasis between nitric oxide, reactive oxygen species and renal oxygenation.
© 2009 Lippincott Williams & Wilkins, Inc.