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Endocrine System in Acute Kidney Injury

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Endocrine Disorders in Kidney Disease

Abstract

Acute kidney injury (AKI) is frequent among hospitalized patients, especially in the intensive care unit (ICU) setting, with 2–5% of cases requiring renal replacement therapy (RRT). The average mortality risk associated with AKI remains very high (about 30% in the adult ICU population), though highly variable (16–49%) and depending on severity of illness, clinical setting, and presence of comorbidities. The implications of the syndrome stem from the key role of the kidneys in fluid and electrolyte/acid-base homeostasis, blood pressure control, and waste product excretion, but are not restricted to it. In fact, because the physiologic role of the kidneys extends to multiple endocrine functions, the occurrence of endocrine abnormalities in the course of AKI may be expected. Not only are several hormones synthesized or activated in the kidney (erythropoietin, angiotensins I and II, vitamin D, etc.), but the organ is also very important for their metabolism and excretion. In addition, the kidney is a target organ for several hormones involved in the regulation of its excretory and endocrine functions (thyroid hormones, antidiuretic hormone, etc.). The present chapter aims at focusing on some of the main renal-endocrine pathways involved in AKI with special regard to the ICU setting. To this end, glucose homeostasis derangements and insulin resistance, the hypothalamus-pituitary-thyroid axis, calcium-phosphorus metabolism and vitamin D, as well as erythropoietin will be reviewed.

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Authors and Affiliations

  1. Renal Failure Unit, Parma University Medical School, Parma, PR, Italy

    Alice Sabatino & Enrico Fiaccadori

  2. Endocrinology of the Development and Aging Unit, Parma University Medical School, Parma, PR, Italy

    Graziano Ceresini & Michela Marina

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  1. Alice Sabatino
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  2. Graziano Ceresini
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  3. Michela Marina
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  4. Enrico Fiaccadori
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Editors and Affiliations

  1. Division of Nephrology and Hypertension, Departments of Medicine and Public Health, University of California Irvine, School of Medicine, Orange, CA, USA

    Connie M. Rhee

  2. Division of Nephrology and Hypertension, Departments of Medicine, Pediatrics, Public Health, and Nursing Sciences, University of California Irvine, School of Medicine, Orange, CA, USA

    Kamyar Kalantar-Zadeh

  3. Division of Endocrinology, Diabetes, and Hypertension, Departments of Medicine and Physiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Gregory A. Brent

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Sabatino, A., Ceresini, G., Marina, M., Fiaccadori, E. (2019). Endocrine System in Acute Kidney Injury. In: Rhee, C., Kalantar-Zadeh, K., Brent, G. (eds) Endocrine Disorders in Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-97765-2_23

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