Skip to main content
SpringerLink
Log in
Book cover

Acute Nephrology for the Critical Care Physician pp 39–56Cite as

Etiology and Pathophysiology of Acute Kidney Injury

  • Chapter

  • 2518 Accesses

Abstract

Acute kidney injury (AKI) is estimated to complicate around 5 % of critical care admissions [1]. AKI frequently occurs in the context of multiple organ failure and entails mortality rates in excess of 40 % despite appropriate therapy [1]. Etiologies for AKI are varied and multiple factors often coexist in critically ill patients. While sepsis and nephrotoxin exposure are major risk factors for AKI in the ICU, direct ischemia/reperfusion (I/R) injury may also play a role, especially in hypovolemic and cardiogenic shock. It seems likely that most patients develop AKI as a result of multiple risk factors [2]. Despite these diverse causes, the ultimate presentation of established AKI is relatively uniform, with renal tubular injury mediating a decline in glomerular filtration rate and in the most severe cases oliguric renal failure. This chapter focuses on the causes and pathophysiology of AKI in critical illness. For clarity we separately discuss AKI etiologies, although it should be reemphasized that in the real world these mechanisms often coexist [3–5].

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.

    Article  CAS  PubMed  Google Scholar 

  2. Bellomo R, Auriemma S, Fabbri A, et al. The pathophysiology of cardiac surgery-associated acute kidney injury (CSA-AKI). Int J Artif Organs. 2008;31:166–78.

    CAS  PubMed  Google Scholar 

  3. Versteilen AM, DiMaggio F, Leemreis JR, et al. Molecular mechanisms of acute renal failure following ischemia/reperfusion. Int J Artif Organs. 2004;27:1019–29.

    CAS  PubMed  Google Scholar 

  4. Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet. 2005;365:417–30.

    Article  CAS  PubMed  Google Scholar 

  5. Kinsey GR, Okusa MD. Pathogenesis of acute kidney injury: foundation for clinical practice. Am J Kidney Dis. 2011;58:291–301.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Langenberg C, Wan L, Egi M, et al. Renal blood flow and function during recovery from experimental septic acute kidney injury. Intensive Care Med. 2007;33:1614–8.

    Article  PubMed  Google Scholar 

  7. Prowle JR, Ishikawa K, May CN, et al. Renal blood flow during acute renal failure in man. Blood Purif. 2009;28:216–25.

    Article  PubMed  Google Scholar 

  8. Dewitte A, Coquin J, Meyssignac B, et al. Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury. Crit Care. 2012;16:R165.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Schnell D, Darmon M. Renal Doppler to assess renal perfusion in the critically ill: a reappraisal. Intensive Care Med. 2012;38:1751–60.

    Article  PubMed  Google Scholar 

  10. Schnell D, Deruddre S, Harrois A, et al. Renal resistive index better predicts the occurrence of acute kidney injury than cystatin C. Shock. 2012;38:592–7.

    Article  CAS  PubMed  Google Scholar 

  11. Darmon M, Schortgen F, Vargas F, et al. Diagnostic accuracy of Doppler renal resistive index for reversibility of acute kidney injury in critically ill patients. Intensive Care Med. 2011;37:68–76.

    Article  PubMed  Google Scholar 

  12. Prowle JR, Molan MP, Hornsey E, et al. Measurement of renal blood flow by phase-contrast magnetic resonance imaging during septic acute kidney injury: a pilot investigation. Crit Care Med. 2012;40:1768–76.

    Article  PubMed  Google Scholar 

  13. Legrand M, Mik EG, Johannes T, et al. Renal hypoxia and dysoxia after reperfusion of the ischemic kidney. Mol Med. 2008;14:502–16.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Schneider A, Johnson L, Goodwin M, et al. Bench-to-bedside review: contrast enhanced ultrasonography – a promising technique to assess renal perfusion in the ICU. Crit Care. 2011;15:157.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Langenberg C, Bellomo R, May C, et al. Renal blood flow in sepsis. Crit Care. 2005;9:R363–74.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Asfar P, Meziani F, Hamel JF, et al. High versus low blood pressure target in patients with septic shock. N Engl J Med. 2014;370:1583–93.

    Article  CAS  PubMed  Google Scholar 

  17. Bourgoin A, Leone M, Delmas A, et al. Increasing mean arterial pressure in patients with septic shock: effects on oxygen variables and renal function. Crit Care Med. 2005;33:780–6.

    Article  CAS  PubMed  Google Scholar 

  18. Morrell ED, Kellum JA, Hallows KR, et al. Epithelial transport during septic acute kidney injury. Nephrol Dial Transplant. 2014;29:1312–9.

    Article  CAS  PubMed  Google Scholar 

  19. Le Dorze M, Legrand M, Payen D, et al. The role of the microcirculation in acute kidney injury. Curr Opin Crit Care. 2009;15:503–8.

    Article  PubMed  Google Scholar 

  20. Abdelkader A, Ho J, Ow CP, et al. Renal oxygenation in acute renal ischemia-reperfusion injury. Am J Physiol Renal Physiol. 2014;306:F1026–38.

    Article  CAS  PubMed  Google Scholar 

  21. Tiwari MM, Brock RW, Megyesi JK, et al. Disruption of renal peritubular blood flow in lipopolysaccharide-induced renal failure: role of nitric oxide and caspases. Am J Physiol Renal Physiol. 2005;289:F1324–32.

    Article  CAS  PubMed  Google Scholar 

  22. Legrand M, Bezemer R, Kandil A, et al. The role of renal hypoperfusion in development of renal microcirculatory dysfunction in endotoxemic rats. Intensive Care Med. 2011;37:1534–42.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Legrand M, Almac E, Mik EG, et al. L-NIL prevents renal microvascular hypoxia and increase of renal oxygen consumption after ischemia-reperfusion in rats. Am J Physiol Renal Physiol. 2009;296:F1109–17.

    Article  CAS  PubMed  Google Scholar 

  24. Legrand M, Kandil A, Payen D, et al. Effects of sepiapterin infusion on renal oxygenation and early acute renal injury after suprarenal aortic clamping in rats. J Cardiovasc Pharmacol. 2011;58:192–8.

    Article  CAS  PubMed  Google Scholar 

  25. Heemskerk S, Pickkers P, Bouw MP, et al. Upregulation of renal inducible nitric oxide synthase during human endotoxemia and sepsis is associated with proximal tubule injury. Clin J Am Soc Nephrol. 2006;1:853–62.

    Article  CAS  PubMed  Google Scholar 

  26. Quoilin C, Mouithys-Mickalad A, Lécart S, et al. Evidence of oxidative stress and mitochondrial respiratory chain dysfunction in an in vitro model of sepsis-induced kidney injury. Biochim Biophys Acta. 1837;2014:1790–800.

    Google Scholar 

  27. Glynne PA, Picot J, Evans TJ. Coexpressed nitric oxide synthase and apical β1 integrins influence tubule cell adhesion after cytokine-induced injury. J Am Soc Nephrol. 2001;12:2370–83.

    CAS  PubMed  Google Scholar 

  28. Bakker J, Grover R, McLuckie A, et al. Administration of the nitric oxide synthetase inhibitor NG-methyl-L-arginine hydrochloride (546C88) by intravenous infusion for up to 72 hours can promote the resolution of shock in patients with severe sepsis: results of a randomized, double-blind, placebo-controlled multicenter study (study no. 144–002). Crit Care Med. 2004;32:1–12.

    Article  CAS  PubMed  Google Scholar 

  29. Peters E, Heemskerk S, Masereeuw R, et al. Alkaline phosphatase: a possible treatment for sepsis-associated acute kidney injury in critically ill patients. Am J Kidney Dis. 2014;63:1038–48.

    Article  CAS  PubMed  Google Scholar 

  30. Peters E, van Elsas A, Heemskerk S, et al. Alkaline phosphatase as a treatment of sepsis-associated acute kidney injury. J Pharmacol Exp Ther. 2013;344:2–7.

    Article  CAS  PubMed  Google Scholar 

  31. Pickkers P, Heemskerk S, Schouten J, et al. Alkaline phosphatase for treatment of sepsis-induced acute kidney injury: a prospective randomized double-blind placebo-controlled trial. Crit Care. 2012;16:R14.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Wan L, Bagshaw SM, Langenberg C, et al. Pathophysiology of septic acute kidney injury: what do we really know? Crit Care Med. 2008;36(4Suppl):S198–203.

    Article  PubMed  Google Scholar 

  33. Gonçalves GM, Zamboni DS, Câmara NO. The role of innate immunity in septic acute kidney injuries. Shock. 2010;34 Suppl 1:22–6.

    Article  PubMed  Google Scholar 

  34. Sanz AB, Sanchez-Nin MD, Ramos AM, et al. NF-κB in renal inflammation. J Am Soc Nephrol. 2010;21:1254–62.

    Article  CAS  PubMed  Google Scholar 

  35. Iglesias J, Marik PE, Levine JS, et al. Elevated serum levels of the type I and type II receptors for tumor necrosis factor-alpha as predictive factors for ARF in patients with septic shock. Am J Kidney Dis. 2003;41:62–75.

    Article  CAS  PubMed  Google Scholar 

  36. Havasi A, Borkan SC. Apoptosis and acute kidney injury. Kidney Int. 2011;80:29–40.

    Article  CAS  PubMed  Google Scholar 

  37. Guo R, Wang Y, Minto AW, et al. Acute renal failure in endotoxemia is dependent on caspase activation. J Am Soc Nephrol. 2004;15:3093–102.

    Article  PubMed  Google Scholar 

  38. Lee SY, Lee YS, Choi HM, et al. Distinct pathophysiologic mechanismas of septic acute kidney injury: role of immune suppression and renal tubular cell apoptosis in murine model of septic acute kidney injury. Crit Care Med. 2012;40:2997–3006.

    Article  CAS  PubMed  Google Scholar 

  39. Liu HF, Liang D, Wang LM, et al. Effects of specific interleukin-1β converting enzyme inhibitor on ischemic acute renal failure in murine models. Acta Pharmacol Sin. 2005;26:1345–51.

    Article  CAS  PubMed  Google Scholar 

  40. Van den Berghe T, Demon D, Bogaert P, et al. Simultaneous targeting of IL-1 and IL-18 is required for protection against inflammatory and septic shock. Am J Respir Crit Care Med. 2014;189:282–91.

    Article  Google Scholar 

  41. Gomez H, Ince C, De Backer D, et al. A unified theory of sepsis-induced acute kidney injury: inflammation, microcirculatory dysfunction, bioenergetics, and the tubular cell adaptation to injury. Shock. 2014;41:3–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  42. Wu X, Guo R, Wang Y, et al. The role of ICAM-1 in endotoxin-induced acute renal failure. Am J Physiol Renal Physiol. 2007;293:F1262–71.

    Article  CAS  PubMed  Google Scholar 

  43. Tőkés-Füzesi M, Woth G, Emyey B, et al. Microparticles and acute renal dysfunction in septic patients. J Crit Care. 2013;28:141–7.

    Article  PubMed  Google Scholar 

  44. Lerolle N, Nochy D, Guérot E, et al. Histopathology of septic shock induced acute kidney injury: apoptosis and leukocytic infiltration. Intensive Care Med. 2010;36:471–8.

    Article  PubMed  Google Scholar 

  45. Langenberg C, Bagshaw SM, May CN, et al. The histopathology of septic acute kidney injury: a systematic review. Crit Care. 2008;12:R38.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Sear JW. Kidney dysfunction in the postoperative period. Br J Anaesth. 2005;95:20–32.

    Article  CAS  PubMed  Google Scholar 

  47. Parekh DJ, Weinberg JM, Ercole B, et al. Tolerance of the human kidney to isolated controlled ischemia. J Am Soc Nephrol. 2013;24:506–17.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  48. Saotome T, Ishikawa K, May CN, et al. The impact of experimental hypoperfusion on subsequent kidney function. Intensive Care Med. 2010;36:533–40.

    Article  PubMed  Google Scholar 

  49. Bossard G, Bourgoin P, Corbeau JJ, et al. Early detection of postoperative acute kidney injury by Doppler renal resistive index in cardiac surgery with cardiopulmonary bypass. Br J Anaesth. 2011;107:891–8.

    Article  CAS  PubMed  Google Scholar 

  50. Versteilen AM, Blaauw N, Di Maggio F, et al. ρ-Kinase inhibition reduces early microvascular leukocyte accumulation in the rat kidney following ischemia-reperfusion injury: roles of nitric oxide and blood flow. Nephron Exp Nephrol. 2011;118:e79–86.

    Article  CAS  PubMed  Google Scholar 

  51. Ramaswamy D, Corrigan G, Polhemus C, et al. Maintenance and recovery stages of postischemic acute renal failure in humans. Am J Physiol Renal Physiol. 2002;282:F271–80.

    Article  PubMed  Google Scholar 

  52. Kwon O, Hong S-M, Sutton TA, et al. Preservation of peritubular capillary endothelial integrity and increasing pericytes may be critical to recovery from postischemia acute kidney injury. Am J Physiol Renal Physiol. 2008;295:F351–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Bonventre JV, Yang L. Cellular pathophysiology of ischemic acute kidney injury. J Clin Invest. 2011;121:4210–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Kakoki M, Hirata Y, Hayakawa H, et al. Effects of tetrahydrobiopterin on endothelial dysfunction in rats with ischemic acute renal failure. J Am Soc Nephrol. 2000;11:301–9.

    CAS  PubMed  Google Scholar 

  55. Arfian N, Emoto N, Vigon-Zellweger N, et al. ET-1 deletion from endothelial cells protects the kidney during the extension phase of ischemia/reperfusion injury. Biochem Biophys Res Commun. 2012;425:443–9.

    Article  CAS  PubMed  Google Scholar 

  56. Sheridan AM, Bonventre JV. Cell biology and molecular mechanisms of injury in ischemic acute renal failure. Curr Opin Nephrol Hypertens. 2000;9:427–34.

    Article  CAS  PubMed  Google Scholar 

  57. Allam R, Scherbaum CR, Darisipudi MN, et al. Histones form dying renal cells aggravate kidney injury via TLR2 and TLR4. J Am Soc Nephrol. 2012;23:1375–88.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Arumugam TV, Shiels IA, Strachan AJ, et al. A small molecule C5a receptor antagonist protects kidneys from ischemia/reperfusion injury in rats. Kidney Int. 2003;63:134–42.

    Article  CAS  PubMed  Google Scholar 

  59. Melnikov VY, Faubel S, Siegmund B, et al. Neutrophil-independent mechanisms of caspase-1-and IL-18-mediated ischemic acute tubular necrosis in mice. J Clin Invest. 2002;110:1083–91.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  60. Singbartl K, Ley K. Leukocyte recruitment and acute renal failure. J Mol Med. 2004;82:91–101.

    Article  PubMed  Google Scholar 

  61. He Z, Lu L, Altman C, et al. Interleukin-18 binding protein transgenic mice are protected against ischemic kidney injury. Am J Physiol Renal Physiol. 2008;295:F1414–21.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  62. Menke J, Iwata Y, Rabacal WA, et al. CSF-1 signals directly to renal tubular epithelial cells to mediate repair in mice. J Clin Invest. 2009;119:2330–42.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  63. Kinsey GR, Sharma R, Okusa MD. Regulatory T cells in AKI. J Am Soc Nephrol. 2013;24:1720–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  64. Saikumar P, Venkatachalam MA. Role of apoptosis in hypoxia/ischemic damage in the kidney. Semin Nephrol. 2003;23:511–21.

    Article  CAS  PubMed  Google Scholar 

  65. Price PM, Safirstein RL, Megyesi J. The cell cycle and acute kidney injury. Kidney Int. 2009;76:604–13.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Kelly KJ, Plotkin Z, Dagher PC. Guanosine supplementation reduces apoptosis and protects renal function in the setting of ischemic injury. J Clin Invest. 2001;108:1291–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  67. Nigam SK, Lieberthal W. Acute renal failure. III. The role of growth factors in the process of renal regeneration and repair. Am J Physiol Renal Physiol. 2000;279:F3–11.

    CAS  PubMed  Google Scholar 

  68. Vargas GA, Hoeflich A, Jehle PM. Hepatocyte growth factor in renal failure: promise and reality. Kidney Int. 2000;57:1426–36.

    Article  CAS  PubMed  Google Scholar 

  69. Liu KD. Molecular mechanisms of recovery from acute renal failure. Crit Care Med. 2003;31(Suppl):S572–81.

    Article  CAS  PubMed  Google Scholar 

  70. Cuttle L, Zhang X-J, Endre ZH, et al. Bcl-XL translocation in renal tubular epithelial cells in vitro protects distal cells from oxidative stress. Kidney Int. 2001;59:1779–88.

    Article  CAS  PubMed  Google Scholar 

  71. Dai C, Yang J, Liu Y. Single injection of naked plasmid encoding hepatocyte growth factor prevents cell death and ameliorates acute renal failure in mice. J Am Soc Nephrol. 2002;13:411–22.

    CAS  PubMed  Google Scholar 

  72. Pannu N, Nadim MK. An overview of drug-induced acute kidney injury. Crit Care Med. 2008;36(Supppl):S216–23.

    Article  CAS  PubMed  Google Scholar 

  73. Perazella MA. Renal vulnerability to drug toxicity. Clin J Am Soc Nephrol. 2009;4:1275–83.

    Article  CAS  PubMed  Google Scholar 

  74. Perazella MA. Drug use and nephrotoxicity in the intensive care unit. Kidney Int. 2012;81:1172–8.

    Article  CAS  PubMed  Google Scholar 

  75. Sharp LS, Rozycki GS, Feliciano DV. Rhabdomyolysis and secondary renal failure in critically ill surgical patients. Am J Surg. 2004;188:801–6.

    Article  PubMed  Google Scholar 

  76. Schetz M, Dasta J, Goldstein S, et al. Drug-induced acute kidney injury. Curr Opin Crit Care. 2005;11:555–65.

    Article  PubMed  Google Scholar 

  77. McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008;51:1419–28.

    Article  PubMed  Google Scholar 

  78. Hoste EJA, Doom S, De Waele J, et al. Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis. Intensive Care Med. 2011;37:1921–31.

    Article  PubMed  Google Scholar 

  79. Isnard Bagnis C, Deray G, Baumelou A, et al. Herbs and the kidney. Am J Kidney Dis. 2004;44:1–11.

    Article  PubMed  Google Scholar 

  80. Reyes JL, Molina-Jijón E, Rodríguez-Muñoz R, et al. Tight junction proteins and oxidative stress in heavy metals induced nephrotoxicity. Biomed Res Int. 2013;2013:730789.

    Article  PubMed Central  PubMed  Google Scholar 

  81. Perazella MA. Drug-induced nephropathy: an update. Expert Opin Drug Saf. 2005;4:689–706.

    Article  CAS  PubMed  Google Scholar 

  82. Oliveira JFP, Silva CA, Barbieri CD, et al. Prevalence and risk factors for aminoglycoside nephrotoxicity in intensive care units. Antimicrob Agents Chemother. 2009;53:2887–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  83. Zimmerman J, Shen MC. Rhabdomyolysis. Chest. 2013;144:1058–65.

    Article  CAS  PubMed  Google Scholar 

  84. Vaglio A, Salvarani C, Buzio C. Retroperitoneal fibrosis. Lancet. 2006;367:241–51.

    Article  PubMed  Google Scholar 

  85. Perazella MA, Markowitz GS. Drug-induced acute interstitial nephritis. Nat Rev Nephrol. 2010;6:461–70.

    Article  CAS  PubMed  Google Scholar 

  86. Rossert J. Drug-induced acute interstitial nephritis. Kidney Int. 2001;60:804–17.

    Article  CAS  PubMed  Google Scholar 

  87. Alfaro R, Vesavada N, Pauesakon P, et al. Cocaine-induced acute interstitial nephritis: a case report and review of the literature. J Nephropathol. 2013;2:204–9.

    PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Anne-Cornélie J. M. de Pont

  2. Adult Critical Care Unit, The Royal London Hospital, Bart’s and the London NHS Trust, London, UK

    John R. Prowle

  3. Department of Anesthesiology and Critical Care, Hôpital Européen Georges Pompidou Assistance Publique-Hopitaux de Paris, Sorbonne Paris Cité, Paris, France

    Mathieu Legrand

  4. Department of Intensive Care Medicine, Erasmus Medical Centre, Doctor Molewaterplein 50-60, Rotterdam, The Netherlands

    A. B. Johan Groeneveld

Authors
  1. Anne-Cornélie J. M. de Pont
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John R. Prowle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mathieu Legrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. B. Johan Groeneveld
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne-Cornélie J. M. de Pont .

Editor information

Editors and Affiliations

  1. Department of Intensive Care, VU University Hospital, Amsterdam, The Netherlands

    Heleen M. Oudemans-van Straaten

  2. Department of Intensive Care Medicine, Anaesthesia Critical Care Collaborative, Research Group (SPACeR) and Faculty of Health Care Sciences, Royal Surrey County Hospital NHS, Foundation Trust, Surrey Perioperative, University of Surrey, Guildford, United Kingdom

    Lui G. Forni

  3. Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands

    A.B. Johan Groeneveld

  4. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

    Sean M. Bagshaw

  5. Division of Intensive Care and Emergency Medicine, Department of General Internal Medicine, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria

    Michael Joannidis

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing

About this chapter

Cite this chapter

de Pont, AC.J.M., Prowle, J.R., Legrand, M., Groeneveld, A.B.J. (2015). Etiology and Pathophysiology of Acute Kidney Injury. In: Oudemans-van Straaten, H., Forni, L., Groeneveld, A., Bagshaw, S., Joannidis, M. (eds) Acute Nephrology for the Critical Care Physician. Springer, Cham. https://doi.org/10.1007/978-3-319-17389-4_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17389-4_4

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17388-7

  • Online ISBN: 978-3-319-17389-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation