Structure and Function of the Kidney in Septic Shock. A Prospective Controlled Experimental Study

Maiden, Matthew J; Otto, Sophia; Brealey, John; Finnis, Mark; Chapman, Marianne J.; Kuchel, Tim; Nash, C.; Edwards, James; Bellomo, Rinaldo

doi:10.1164/rccm.201511-2285oc

Cited by 105 publications

(75 citation statements)

References 44 publications

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“…Renal hypotension and associated ischemia had been believed to be the primary lesion in SA-AKI, but more recently several animal models have shown that although tubular cell injury and expression of markers such as KIM-1 are common, inflammation and apoptosis are also playing a role 8990. These data fit with the evolving view of multifocal organ injury including macrovascular and microvascular dysfunction and immunologic and autonomic dysregulation.…”

Section: Pathobiology Of Sa-akimentioning

confidence: 54%

“…Septic animals (n=10) had increased mesangial expansion on electron microscopy compared with non-septic animals, but no significant structural disturbances were found compared with controls (n=5) 90. Although surprising, these findings may be valid given that larger animals better mimic the human cardiovascular response in sepsis 90100101102. More specifically, ovine autoregulatory responses in untreated shock and shock treated with vasoactive drugs are similar to those in human kidneys with AKI 100101103.…”

Section: Pathobiology Of Sa-akimentioning

confidence: 81%

“…In an ovine model, no association was seen between early SA-AKI and histopathologic lesions on renal biopsy 90. Septic animals (n=10) had increased mesangial expansion on electron microscopy compared with non-septic animals, but no significant structural disturbances were found compared with controls (n=5) 90.…”

Section: Pathobiology Of Sa-akimentioning

confidence: 93%

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Sepsis associated acute kidney injury

Poston

Koyner

2019

BMJ

514

381

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Sepsis is defined as organ dysfunction resulting from the host’s deleterious response to infection. One of the most common organs affected is the kidneys, resulting in sepsis associated acute kidney injury (SA-AKI) that contributes to the morbidity and mortality of sepsis. A growing body of knowledge has illuminated the clinical risk factors, pathobiology, response to treatment, and elements of renal recovery that have advanced our ability to prevent, detect, and treat SA-AKI. Despite these advances, SA-AKI remains an important concern and clinical burden, and further study is needed to reduce the acute and chronic consequences. This review summarizes the relevant evidence, with a focus on the risk factors, early recognition and diagnosis, treatment, and long term consequences of SA-AKI. In addition to literature pertaining to SA-AKI specifically, pertinent sepsis and acute kidney injury literature relevant to SA-AKI was included.

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Section: Pathobiology Of Sa-akimentioning

confidence: 54%

Section: Pathobiology Of Sa-akimentioning

confidence: 81%

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Sepsis associated acute kidney injury

Poston

Koyner

2019

BMJ

514

381

View full text Add to dashboard Cite

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“…Supporting the notion that organ failure does not occur because of tissue damage, the decrease in kidney function that accompanies sepsis was recently shown to occur without cellular changes or tissue damage to account for the marked reduction in glomerular filtration [46]. In an animal model of sepsis, blood flow to the kidney was preserved, there was no evidence of inflammation, no tubular cell necrosis or blood vessel damage.…”

Section: Organ Failurementioning

confidence: 88%

“…Recovery from acute kidney injury returned survivors to presepsis levels of function, suggesting there is no long term damage. Maiden et al concluded from these findings that septic acute kidney injury is a functional response, in other words an adaptation [46].…”

Section: Organ Failurementioning

confidence: 97%

The Emperor Has no Clothes? Searching for Dysregulation in Sepsis

Alcock

2018

Preprint

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The core conception of sepsis -that it is a dysregulated state -is a powerful and durable ideathat has inspired decades of research into sepsis. But is it true that the body's response to sepsis is dysregulated? To answer that question, this review surveyed the history of trials of agents targeting the host response. Sepsis survival is not improved by blocking one or many immune pathways. Similarly, sepsis is resistant to treatment by normalizing one or many physiologic parameters simultaneously. The vast majority of interventions are either ineffective or harmful.With this track record of failure, it is time to consider the null hypothesis -regulation instead of dysregulation -and possibility that sepsis traits are often functional, and do more harm than good. This review discusses the implications of this perspective for the future of sepsis research.

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Diagnostic value of ultrasound and contrast‐enhanced ultrasound in septic acute kidney injury

Liu

Ding

Zhang

et al. 2021

J of Clinical Ultrasound

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Purpose This study aimed to explore the clinical value of ultrasonic Doppler examination and contrast‐enhanced ultrasound (US) in the circulation of septic acute kidney injury (AKI). Methods Patients with intensive care unit‐related infection were divided into AKI group and control groups. The AKI group was divided into three subgroups according to the serum creatinine value: stage 1, stage 2, and stage 3. Relevant parameters and blood flow of the renal artery were measured, and further contrast‐enhanced US was performed and time‐intensity curve was analyzed. Results The renal blood flow (RBF) and time‐averaged velocity decreased significantly in the AKI group compared with the control group (p = .021 and p = .001). The peak value decreased and time to peak (TTP) prolonged in the AKI group (p < .001). With the aggravation of the disease, the RBF decreased slightly among subgroups (p = 0.124). However, the peak value gradually decreased and the TTP prolonged (all p < .05). The multiple linear regression model showed that only PI, RI, and TTP were independently and linearly correlated with the serum creatinine value. Conclusions Doppler US and contrast‐enhanced US are of great help in the detection of condition changes and prognosis of patients with sepsis‐induced AKI.

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Structure and Function of the Kidney in Septic Shock. A Prospective Controlled Experimental Study

Abstract: In an intensive care-supported model of gram-negative septic shock, early AKI was not associated with changes in renal blood flow, oxygen delivery, or histological appearance. Other mechanisms must contribute to septic AKI.

Cited by 105 publications

References 44 publications

Sepsis associated acute kidney injury

Sepsis associated acute kidney injury

The Emperor Has no Clothes? Searching for Dysregulation in Sepsis

Diagnostic value of ultrasound and contrast‐enhanced ultrasound in septic acute kidney injury

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