ABSTRACTS from 16th International COnference on ... - CRRT Online

Distant Organ Responses in AKI
Hamid Rabb MD
5:15-5:30
Wednesday, February 15
Educational Objectives:
1. Describe scope of the clinical problem of distant organ dysfunction during AKI
2. Present the evidence supporting kidney-distant organ cross-talk in acute kidney injury
3. Describe newly recognized mechanisms and pathways that underlie this syndrome
Content Description:
Acute lung injury (ALI) requiring mechanical ventilation is commonly associated with AKI, and lung dysfunction
is highly correlated with death in the patient with AKI. Astute clinicians have recognized that pulmonary
symptoms occur frequently with renal failure, and that the degree of pulmonary dysfunction appears to exceed
that purely attributable to fluid overload. Despite the close clinical linkage of ALI and AKI, there is little mechanistic
information regarding how these organs interact in the critically ill patient. Recent data has unveiled a role
for inflammatory mediators and electrolyte transporter abnormalities in accentuating the vicious cycle of kidneylung
injury. Furthermore, injurious lung ventilation strategies likely predispose the kidney to additional insults by
amplifying inflammatory and pro-apoptotic pathways. AKI also has a direct effect on brain function as well as
effects on liver and heart. An improved understanding of the mechanisms and pathways that mediate AKI
induced distant organ dysfunction is important so that we can develop dialysis as well as other strategies to
improve the high morbidity and mortality during AKI.
Suggested Reading:
1. Kramer A, Postler G, Salhab K, Mendez C, Carey L, Rabb H. Renal ischemia/reperfusion leads to
macrophage-mediated increase in pulmonary vascular permeability. Kidney Int 55:2362-7, 1999
2. Pannu N, Mehta RL Mechanical ventilation and renal function: an area for concern?
Am J Kidney Dis 39:616-24, 2002
3. Imai Y, Parodo J, Kajikawa O, de Perrot M, Fischer S, Edwards V, Cutz E, Liu M, Keshavjee S, Martin TR,
Marshall JC, Ranieri VM, Slutsky AS . Injurious mechanical ventilation and end-organ epithelial cell apoptosis
and organ dysfunction in an experimental model of acute respiratory distress syndrome. JAMA 289:2104-12,
2003
4. Hoke TS, Douglas IS, Klein CL, He Z, Fang W, Thurman JM, Tao Y, Dursun B, Voelkel NF, Edelstein CL,
Faubel S. Acute renal failure after bilateral nephrectomy is associated with cytokine-mediated pulmonary injury.
J Am Soc Nephrol 18: 155-64, 2007.
5. Liu M, Liang Y, Chigurupati S, Lathia JD, Pletnikov M, Sun Z, Crow M, Ross CA, Mattson MP, Rabb H.
Acute kidney injury leads to inflammation and functional changes in the brain.
J Am Soc Nephrol 19:1360-70, 2008
6. Hassoun HT, Lie ML, Grigoryev DN, Liu M, Tuder RM, Rabb H. Kidney ischemia-reperfusion injury induces
caspase-dependent pulmonary apoptosis. Am J Physiol Renal. 297:F125-37, 2009
7. Golab F, Kadkhodaee M, Zahmatkesh M, Hedayati M, Arab H, Schuster R, Zahedi K, Lentsch AB, Soleimani
M. Ischemic and non-ischemic acute kidney injury cause hepatic damage. Kidney Int 75:783-92, 2009
8. Grams M, Rabb H. The distant organ effects of acute kidney injury. Kidney Int Aug 3(epub), 2011
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