串扰
医学
器官功能障碍
急性肾损伤
趋化因子
促炎细胞因子
肾
心肾综合症
心脏功能不全
炎症
免疫功能障碍
免疫系统
病理生理学
调解人
重症监护医学
生物信息学
免疫学
败血症
病理
内科学
心力衰竭
生物
物理
光学
作者
Xiang Li,Heitham T. Hassoun,Rachel J. Santora,Hamid Rabb
出处
期刊:Current Opinion in Critical Care
[Ovid Technologies (Wolters Kluwer)]
日期:2009-12-01
卷期号:15 (6): 481-487
被引量:174
标识
DOI:10.1097/mcc.0b013e328332f69e
摘要
Acute kidney injury (AKI) continues to contribute significantly to morbidity and mortality in the ICU setting, especially when associated with distant organ dysfunction. There is increasing evidence that AKI directly contributes to organ dysfunction in lung, brain, liver, heart and other organs. This review will examine our current understanding of the deleterious organ crosstalk in the critically ill, which can provide a framework for developing novel therapeutics.The majority of studies correlating AKI with distant organ dysfunction have demonstrated the pathophysiological importance of proinflammatory and proapoptotic pathways as well as oxidative stress and reactive oxygen species (ROS) production. Leukocyte activation and infiltration, changes in levels of soluble factors such as cytokines and chemokines, and regulation of cell death in extra-renal organs are potentially important mechanisms by which AKI modulates multiorgan dysfunction.There is increasing knowledge of AKI and deleterious interorgan crosstalk that arises, at least in part, due to the imbalance of immune, inflammatory, and soluble mediator metabolism that attends severe insults to the kidney. Further studies can build on these new mechanistic observations to develop strategies to improve outcomes in the critically ill patient.
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