Información del artículo
Resumen
En los últimos años se ha avanzado en el conocimiento acerca de la lesión renal y de la pulmonar agudas. La lesión renal aguda ocurre en la mayoría de los pacientes con lesión pulmonar aguda. Asimismo, los pacientes con lesión renal aguda tienen alto riesgo de desarrollar lesión pulmonar aguda. Ambas lesiones coexisten en los pacientes críticamente enfermos y esto resulta en un peor pronóstico. Varios mecanismos inflamatorios y neurohormonales favorecen lesiones directas e indirectas que alteran la funcionalidad pulmonar y renal. La siguiente revisión describe los mecanismos fisiopatológicos implicados en la interacción riñón-pulmón. También se describen las terapias usadas en ambas lesiones orgánicas que podrían prevenir el desarrollo de la otra.
Palabras clave:
Lesión pulmonar aguda
Lesión renal aguda
Ventilación mecánica
Síndrome de dificultad respiratoria aguda
Interacción riñón-pulmón
Abstract
The past few years have seen major advances in the understanding of both acute kidney and lung injuries. Acute kidney injury occurs in the majority of patients with acute lung injury. Patients with acute kidney injury are also at higher risk of developing acute lung injury. Both organ injuries co-exist in the majority of critically ill patients and result in worse outcomes. A series of inflammatory and neuro-hormonal cascades occur, resulting in direct and indirect injuries that lead to disruption of normal kidney and lung function. The following paper describes the pathophysiological mechanisms involved in kidney-lung crosstalk. A description is also presented on the therapies used to treat both these organ injuries that may prevent the development of the other.
Keywords:
Acute lung injury
Acute kidney injury
Mechanical ventilation
Respiratory distress syndrome
Kidney-lung crosstalk
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Bibliografía
[1]
J.L. Koyner, P.T. Murray.
Mechanical ventilation and the kidney.
Blood Purif., 29 (2010), pp. 52-68
[2]
D. Breen, D. Bihari.
Acute renal failure as a part of multiple organ failure: The slippery slope of critical illness.
Kidney Int Suppl., 66 (1998), pp. S25-S33
[3]
J.A. Kellum.
Acute kidney injury.
Crit Care Med., 36 (2008), pp. S141-S145
[4]
E.A. Hoste, S.M. Bagshaw, R. Bellomo, C.M. Cely, R. Colman, D.N. Cruz, et al.
Epidemiology of acute kidney injury in critically ill patients: The multinational AKI-EPI study.
Intensive Care Med., 41 (2015), pp. 1411-1423
[5]
P.T. Murray.
The kidney in respiratory failure and mechanical ventilation.
Contrib Nephrol. V 165, (2010), pp. 159-165
[6]
L.B. Ware, M.A. Matthay.
The acute respiratory distress syndrome.
N Engl J Med., 342 (2000), pp. 1334-1349
[7]
G.R. Bernard, A. Artigas, K.L. Brigham, J. Carlet, K. Falke, L. Hudson, et al.
The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination.
Am J Respir Crit Care Med., 149 (1994), pp. 818-824
[8]
V.M. Ranieri, G.D. Rubenfeld, B.T. Thompson, N.D. Ferguson, E. Caldwell, E. Fan, ARDS Definition Task Force, et al.
Acute respiratory distress syndrome: The Berlin Definition.
JAMA, 307 (2012), pp. 2526-2533
[9]
C.E. Behrendt.
Acute respiratory failure in the United States: Incidence and 31-day survival.
Chest., 118 (2000), pp. 1100-1105
[10]
H. Wunsch, W.T. Linde-Zwirble, D.C. Angus, M.E. Hartman, E.B. Milbrandt, J.M. Kahn.
The epidemiology of mechanical ventilation use in the United States.
Crit Care Med., 38 (2010), pp. 1947-1953
[11]
A.D. Bersten, C. Edibam, T. Hunt, J. Moran, Australian and New Zealand Intensive Care Society Clinical Trials Group.
Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian States.
Am J Respir Crit Care Med., 165 (2002), pp. 443-448
[12]
M. Hughes, F.N. MacKirdy, J. Ross, J. Norrie, I.S. Grant, Scottish Intensive Care Society.
Acute respiratory distress syndrome: An audit of incidence and outcome in Scottish intensive care units.
Anaesthesia, 58 (2003), pp. 838-845
[13]
M.A. Matthay, R.L. Zemans.
The acute respiratory distress syndrome: Pathogenesis and treatment.
Annu Rev Pathol., 6 (2011), pp. 147-163
[14]
N.H. Lameire, A. Bagga, D. Cruz, J. de Maeseneer, Z. Endre, J.A. Kellum, et al.
Acute kidney injury: An increasing global concern.
Lancet., 382 (2013), pp. 170-179
[15]
R. Bellomo, C. Ronco, J.A. Kellum, R.L. Mehta, P. Palevsky, Acute Dialysis Quality Initiative workgroup.
Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group.
Crit Care., 8 (2004), pp. R204-R212
[16]
R.L. Mehta, J.A. Kellum, S.V. Shah, B.A. Molitoris, C. Ronco, D.G. Warnock, Acute Kidney Injury Network, et al.
Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury.
Crit Care., 11 (2007), pp. R31
[17]
D. Fliser, M. Laville, A. Covic, D. Fouque, R. Vanholder, L. Juillard, Ad-hoc working group of ERBP, et al.
A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: Definitions, conservative management and contrast-induced nephropathy.
Nephrol Dial Transplant., 27 (2012), pp. 4263-4272
[18]
L.X. Chen, J.L. Koyner.
Biomarkers in acute kidney injury.
Crit Care Clin., 31 (2015), pp. 633-648
[19]
The Acute Respiratory Distress Syndrome Network.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.
N Engl J Med., 342 (2000), pp. 1301-1308
[20]
H.P. Wiedemann, A.P. Wheeler, G.R. Bernard, B.T. Thompson, D. Hayden, B. deBoisblanc, National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, et al.
Comparison of two fluid-management strategies in acute lung injury.
N Engl J Med., 354 (2006), pp. 2564-2575
[21]
J.P. Van den Akker, M. Egal, A.B. Groeneveld.
Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: A systematic review and meta-analysis.
Crit Care., 17 (2013), pp. R98
[22]
R.L. Mehta, M.T. Pascual, S. Soroko, B.R. Savage, J. Himmelfarb, T.A. Ikizler, et al.
Spectrum of acute renal failure in the intensive care unit: The PICARD experience.
Kidney Int., 66 (2004), pp. 1613-1621
[23]
K.D. Liu, D.V. Glidden, M.D. Eisner, P.E. Parsons, L.B. Ware, A. Wheeler, et al.
Predictive and pathogenetic value of plasma biomarkers for acute kidney injury in patients with acute lung injury.
Crit Care Med., 35 (2007), pp. 2755-2761
[24]
C.T. Chao, V.C. Wu, T.W. Kao.
Acute kidney injury, a second hit for the prolonged ventilated population: Necessity for cost effectiveness studies.
IJHIE, 1 (2013),
[25]
C.T. Chao, C.C. Hou, V.C. Wu, H.M. Lu, C.Y. Wang, L. Chen, et al.
The impact of dialysis-requiring acute kidney injury on long-term prognosis of patients requiring prolonged mechanical ventilation: Nationwide population-based study.
PLoS One., 7 (2012), pp. e50675
[26]
C.R. Parikh, E. Abraham, M. Ancukiewicz, C.L. Edelstein.
Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit.
J Am Soc Nephrol, 16 (2005), pp. 3046-3052
[27]
K.D. Liu, D.V. Glidden, M.D. Eisner, P.E. Parsons, L.B. Ware, A. Wheeler, National Heart, Lung, and Blood Institute ARDS Network Clinical Trials Group, et al.
Predictive and pathogenetic value of plasma biomarkers for acute kidney injury in patients with acute lung injury.
Crit Care Med, 35 (2007), pp. 2755-2761
[28]
G.J. Ko, H. Rabb, H.T. Hassoun.
Kidney-lung crosstalk in the critically ill patient.
Blood Purif., 28 (2009), pp. 75-83
[29]
N. Pannu, R.L. Mehta.
Effect of mechanical ventilation on the kidney.
Best Pract Res Clin Anaesthesiol., 18 (2004), pp. 189-203
[30]
J.L. Koyner, P.T. Murray.
Mechanical ventilation and lung-kidney interactions.
Clin J Am Soc Nephrol., 3 (2008), pp. 562-570
[31]
C.D. Douillet, W.P. Robinson 3rd, B.L. Zarzaur, E.R. Lazarowski, R.C. Boucher, P.B. Rich.
Mechanical ventilation alters airway nucleotides and purinoceptors in lung and extrapulmonary organs.
Am J Respir Cell Mol Biol., 32 (2005), pp. 52-58
[32]
Y. Imai, J. Parodo, O. Kajikawa, M. de Perrot, S. Fischer, V. Edwards, et al.
Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome.
JAMA., 289 (2003), pp. 2104-2112
[33]
J.W. Kuiper, R. Vaschetto, F. Della Corte, F.B. Plötz, A.B. Groeneveld.
Bench-to-bedside review: Ventilation-induced renal injury through systemic mediator release--just theory or a causal relationship?.
Crit Care., 15 (2011), pp. 228
[34]
W.I. Choi, D.A. Quinn, K.M. Park, R.K. Moufarrej, B. Jafari, O. Syrkina, et al.
Systemic microvascular leak in an in vivo rat model of ventilator-induced lung injury.
Am J Respir Crit Care Med., 167 (2003), pp. 1627-1632
[35]
V.M. Ranieri, P.M. Suter, C. Tortorella, R. de Tullio, J.M. Dayer, A. Brienza, et al.
Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: A randomized controlled trial.
JAMA., 282 (1999), pp. 54-61
[36]
V.M. Ranieri, F. Giunta, P.M. Suter, A.S. Slutsky.
Mechanical ventilation as a mediator of multisystem organ failure in acute respiratory distress syndrome.
JAMA., 284 (2000), pp. 43-44
[37]
B. Cortjens, A.A. Royakkers, R.M. Determann, J.D. van Suijlen, S.S. Kamphuis, J. Foppen, et al.
Lung-protective mechanical ventilation does not protect against acute kidney injury in patients without lung injury at onset of mechanical ventilation.
J Crit Care., 27 (2012), pp. 261-267
[38]
P.P. Tak, D.M. Gerlag, K.R. Aupperle, D.A. van de Geest, M. Overbeek, B.L. Bennett, et al.
Inhibitor of nuclear factor kappaB kinase beta is a key regulator of synovial inflammation.
Arthritis Rheum., 44 (2001), pp. 1897-1907
[39]
J.G. Laffey, M. Tanaka, D. Engelberts, X. Luo, S. Yuan, A.K. Tanswell, et al.
Therapeutic hypercapnia reduces pulmonary and systemic injury following in vivo lung reperfusion.
Am J Respir Crit Care Med., 162 (2000), pp. 2287-2294
[40]
P.G. Vallés, A.G. Lorenzo, V. Bocanegra, R. Vallés.
Acute kidney injury: What part do toll-like receptors play?.
Int J Nephrol Renovasc Dis., 7 (2014), pp. 241-251
[41]
S.E. Sinclair, D.A. Kregenow, W.J. Lamm, I.R. Starr, E.Y. Chi, M.P. Hlastala.
Hypercapnic acidosis is protective in an in vivo model of ventilator-induced lung injury.
Am J Respir Crit Care Med., 166 (2002), pp. 403-408
[42]
W. Druml.
Systemic consequences of acute kidney injury.
Curr Opin Crit Care., 20 (2014), pp. 613-619
[43]
K. Doi, T. Ishizu, T. Fujita, E. Noiri.
Lung injury following acute kidney injury: Kidney-lung crosstalk.
Clin Exp Nephrol., 15 (2011), pp. 464-470
[44]
E.C. Rackow, I.A. Fein.
Fulminant noncardiogenic pulmonary edema in the critically ill.
Crit Care Med., 6 (1978), pp. 360-363
[45]
H. Rabb, Z. Wang, T. Nemoto, J. Hotchkiss, N. Yokota, M. Soleimani.
Acute renal failure leads to dysregulation of lung salt and water channels.
Kidney Int., 63 (2003), pp. 600-606
[46]
A.A. Kramer, G. Postler, K.F. Salhab, C. Mendez, L.C. Carey, H. Rabb.
Renal ischemia/reperfusion leads to macrophage-mediated increase in pulmonary vascular permeability.
Kidney Int., 55 (1999), pp. 2362-2367
[47]
T.S. Hoke, I.S. Douglas, C.L. Klein, Z. He, W. Fang, J.M. Thurman, et al.
Acute renal failure after bilateral nephrectomy is associated with cytokine-mediated pulmonary injury.
J Am Soc Nephrol., 18 (2007), pp. 155-164
[48]
C.L. Klein, T.S. Hoke, W.F. Fang, C.J. Altmann, I.S. Douglas, S. Faubel.
Interleukin-6 mediates lung injury following ischemic acute kidney injury or bilateral nephrectomy.
Kidney Int., 74 (2008), pp. 901-909
[49]
H. Chiao, Y. Kohda, P. McLeroy, L. Craig, I. Housini, R.A. Star.
Alphamelanocyte-stimulating hormone protects against renal injury after ischemia in mice and rats.
J Clin Invest., 99 (1997), pp. 1165-1172
[50]
F. Husain-Syed, P.A. McCullough, H.W. Birk, M. Renker, A. Brocca, W. Seeger, et al.
Cardio-pulmonary-renal interactions: A multidisciplinary approach.
J Am Coll Cardiol., 65 (2015), pp. 2433-2448
[51]
J.R. Prowle, J.E. Echeverri, E.V. Ligabo, C. Ronco, R. Bellomo.
Fluid balance and acute kidney injury.
Nat Rev Nephrol., 6 (2010), pp. 107-115
[52]
P. Piccinni, M. Dan, S. Barbacini, R. Carraro, E. Lieta, S. Marafon, et al.
Early isovolaemic haemofiltration in oliguric patients with septic shock.
Intensive Care Med., 32 (2006), pp. 80-86
