When kidneys and lungs suffer together

Abstract

A significant interaction between kidneys and lungs has been shown in physiological and pathological conditions. The two organs can both be targets of the same systemic disease (eg., some vasculitides). Moreover, loss of normal function of either of them can induce direct and indirect dysregulation of the other one. Subjects suffering from COPD may have systemic inflammation, hypoxemia, endothelial dysfunction, increased sympathetic activation and increased aortic stiffness. As well as the exposure to nicotine, all the foresaid factors can induce a microvascular damage, albuminuria, and a worsening of renal function. Renal failure in COPD can be unrecognized since elderly and frail patients may have normal serum creatinine concentration. Lungs and kidneys participate in maintaining the acid-base balance. Compensatory role of the lungs rapidly expresses through an increase or reduction of ventilation. Renal compensation usually requires a few days as it is achieved through changes in bicarbonate reabsorption. Chronic kidney disease and end-stage renal diseases increase the risk of pneumonia. Vaccination against Streptococcus pneumonia and seasonal influenza is recommended for these patients. Vaccines against the last very virulent H1N1 influenza A strain are also available and effective. Acute lung injury and acute kidney injury are frequent complications in critical illnesses, associated with high morbidity and mortality. The concomitant failure of kidneys and lungs implies a multidisciplinary approach, both in terms of diagnostic processes and therapeutic management.

Diagnostic potential of circulating cell‐free microRNAs for community‐acquired pneumonia and pneumonia‐related sepsis

“…NGAL has recently been described as a useful biomarker for lower respiratory tract infections 33 and the associated mortality 34 and may also serve as an indicator of an ongoing risk for renal injury, 35 which is common in patients with pulmonary disorders. 36 Moreover, expression levels of miR-193a-5p were related to the duration of the required hospital stay in our study. Identified molecular targets of miR-193a-5p included IL-10, which is known to correlate with the CURB-65 score and is associated with increased mortality in patients with CAP 37 and mTOR, which has been shown to be down-regulated in sepsis due to CAP.…”

“…The miR‐193a/b‐5p family was previously shown to be a possible indicator for CAP, as expression of miR‐193b‐5p was related to the CURB‐65 score, a validated clinical prediction score for pneumonia and the associated risk of mortality 8 and also to NGAL plasma levels. NGAL has recently been described as a useful biomarker for lower respiratory tract infections 33 and the associated mortality 34 and may also serve as an indicator of an ongoing risk for renal injury, 35 which is common in patients with pulmonary disorders 36 . Moreover, expression levels of miR‐193a‐5p were related to the duration of the required hospital stay in our study.…”

Sympathetic activation: a potential link between comorbidities and COVID‐19

“…Acute kidney injury has been reported in > 20% of severe or deceased COVID‐19 patients, and chronic kidney diseases are also significantly associated with severe COVID‐19 [2]. Moreover, the above mechanisms involved in the vicious cycle between sympathetic overactivity and renal function also show detrimental effects on the cardiocirculatory [38,39] and lung [40] functions. Thus, it appears reasonable that sympathetic activation in comorbidities may exert negative homeostasis effects in COVID‐19 also through renal effects.…”

Cardiovascular Functional Changes in Chronic Kidney Disease: Integrative Physiology, Pathophysiology and Applications of Cardiopulmonary Exercise Testing

“…For example, pulmonary-renal syndromes due to small-vessel vasculitis can cause significant renal impairment, including rapidly progressive glomerulonephritis (RPGN) and pulmonary hemorrhage. Diabetes can cause diabetic nephropathy as well as impaired lung function, involving decreased lung diffusion capacity and increased risk for pulmonary hypertension (Sorino et al, 2019). Additionally, the development of restrictive lung disease has been associated with progressive CKD (Mukai et al, 2018).…”