Endocrine System in Acute Kidney Injury

  • Alice Sabatino
  • Graziano Ceresini
  • Michela Marina
  • Enrico Fiaccadori


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.


Acute kidney injury Calcium-phosphorus metabolism Critical illness Erythropoietin Glucose homeostasis Hormones Hypothalamus-pituitary-thyroid axis Insulin resistance Intensive care unit Vitamin D 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alice Sabatino
    • 1
  • Graziano Ceresini
    • 2
  • Michela Marina
    • 2
  • Enrico Fiaccadori
    • 1
  1. 1.Renal Failure Unit, Parma University Medical SchoolParmaItaly
  2. 2.Endocrinology of the Development and Aging Unit, Parma University Medical SchoolParmaItaly

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