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The Kidney in Sepsis

  • J. A. Kellum
Conference paper

Abstract

The kidney is a significant target organ for the sepsis syndrome and, depending on the definitions used, acute renal failure (ARF) occurs in as many as 15% of patients with critical illness [1] and sepsis appears to be a contributing factor in as many as 43 %[2] . In addition, the kidney is usually the organ that fails first [3]. While the mortality rate of isolated acute renal failure is approximately 10 to 15%, ARF in the setting of sepsis carries a mortality rate between 50 to 90% according to published series. In a recent study [4], the mortality rate among 253 cases of ARF treated in the ICU was 71.5% whereas it was 31.5% among the 495 cases of ARF treated in a non-ICU setting (p = 0.001).

Keywords

Acute Renal Failure Mean Arterial Pressure Renal Injury Renal Blood Flow Renal Vascular Resistance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Brivet FG, Kleinknecht DJ, Loirat P et al (1996) Acute renal failure in intensive care units — causes, outcomes and prognostic factors of hospital mortality: a prospective multicenter study. Crit Care Med 24:192–198PubMedCrossRefGoogle Scholar
  2. 2.
    Myers BD, Moran SM (1986) Hemodynamically mediated acute renal failure. N Engl J Med 314:97–100PubMedCrossRefGoogle Scholar
  3. 3.
    Tran DD, Oe PL, de Fijter CWH et al (1993) Acute renal failure in patients with acute pancreatitis: Prevalence, risk factors, and outcome. Nephrol Dial Transplant 8:1079–1084PubMedGoogle Scholar
  4. 4.
    Mccullough PA, Wolyn R, Rocher LL et al (1997) Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality. Am J Med 103:368–375PubMedCrossRefGoogle Scholar
  5. 5.
    Dishart MK, Kellum JA (1999) An Evaluation of Pharmacologic Strategies for the Prevention and Treatment of Acute Renal Failure (ARF). Drugs (in press)Google Scholar
  6. 6.
    Kellum JA (1997) The use of diuretics and dopamine in acute renal failure: a systematic review of the evidence. Crit Care 1:53–59PubMedCrossRefGoogle Scholar
  7. 7.
    Kellum JA (1998) Primum non nocere and the meaning of modern critical care. Curr Op Crit Care 4:400–405CrossRefGoogle Scholar
  8. 8.
    Kellum JA (1997) Endotoxin and renal blood flow. Blood Purif 15:286–291PubMedCrossRefGoogle Scholar
  9. 9.
    Danner RL, Elin RJ, Hosseini JM et al (1991) Endotoxemia in human septic shock. Chest 99:169–175PubMedCrossRefGoogle Scholar
  10. 10.
    Hoffman WD, Natanson C (1993) Endotoxin in septic shock. Anesth Analg 77:613–624PubMedGoogle Scholar
  11. 11.
    Zivot JB, Hoffman WD (1995) Pathogenic effects of endotoxin. New Horizons 3:267–275PubMedGoogle Scholar
  12. 12.
    Lugon JR, Boim MA, Ramos OL et al (1989) Renal function and glomerular hemodynamics in male endoxemic rats. Kidney Int 36:570–575PubMedCrossRefGoogle Scholar
  13. 13.
    Danner RL, Natanson C, Elin RJ et al (1990) P. aeruginosa compared with E. coli produces less endotoxemia but more cardiovascular dysfunction and mortality in a canine model of septic shock. Chest 98:1480–1487PubMedCrossRefGoogle Scholar
  14. 14.
    Hoffman WD, Danner RL, Quezado ZM (1996) Role of endotoxemia in cardiovascular dysfunction and lethality: virulent and nonvirulent Escherichia coli challenges in a canine model of septic shock. Infect Immun 64:406–412PubMedGoogle Scholar
  15. 15.
    Cohen JJ, Black AJ, Wertheim SJ (1990) Direct effects of endotoxin on the function of the isolated perfused rat kidney. Kidney Int 37:1219–1226PubMedCrossRefGoogle Scholar
  16. 16.
    Burnier M, Waeber B, Aubert JF et al (1988) Effects of nonhypotensive endotoxemia in conscious rats: Role of prostaglandins. Am J Physiol 254:H509–H516PubMedGoogle Scholar
  17. 17.
    Walker JF, Cumming AD, Lindsay RM et al (1986) The renal response produced by non hypotensive sepsis in a large animal model. Am J Kidney Dis 8:88–97PubMedGoogle Scholar
  18. 18.
    Bellomo R, Kellum JA, Wisniewski S, Pinsky MR (1999) Effects of norepinephrine on renal vascular resistance and renal blood flow in normal and endotoxemic dogs. Am J Resp Crit Care Med 159:1186–1192PubMedGoogle Scholar
  19. 19.
    Hou SH, Bushinsky DA, Wish JB et al (1983) Hospital-acquired renal insufficiency: A prospective study. Am J Med 74:243–248PubMedCrossRefGoogle Scholar
  20. 20.
    Iwase K, Takenaka H, Ishizaka I et al (1993) Serial changes in renal function during laparoscopic cholecystectomy. Eur Surg Res 25:203–212PubMedCrossRefGoogle Scholar
  21. 21.
    Shipley RE, Study RS (1951) Changes in renal blood flow, extraction of insulin glomerular filtration rate, tissue pressure, and urine flow with acute alterations in renal artery pressure. Am J Physiol 167:676–688PubMedGoogle Scholar
  22. 22.
    Stone AM, Stahl WM (1970) Renal effects of hemorrhage in normal man. Ann Surg 172: 825–836PubMedCrossRefGoogle Scholar
  23. 23.
    Bersten AD, Holt AW (1995) Vasoactive drugs and the importance of renal perfusion pressure. New Horizons 1995;3(4):650–661PubMedGoogle Scholar
  24. 24.
    Kircheim HR, Ehmke H, Hackenthal E et al (1987) Autoregulation of renal blood flow, glomerular filtration rate and renin release in conscious dogs. Pflugers Arch 410: 441–449CrossRefGoogle Scholar
  25. 25.
    Kelleher SP, Robinette JB, Conger JD (1984) Sympathetic nervous system in the loss of autoregulation in acute renal failure. Am J Physiol 246:F379–F386PubMedGoogle Scholar
  26. 26.
    Barret BJ (1994) Contrast nephrotoxicity. J Am Soc Nephrol 5:125–137Google Scholar
  27. 27.
    Solomon R, Werner C, Mann D et al (1994) Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med 331:1416–1420PubMedCrossRefGoogle Scholar
  28. 28.
    Heyman SN, Brezis M, Epstien FH et al (1991) Early renal medullary hypoxic injury from radiocontrast and indomethacin. Kidney Int 40:632–642PubMedCrossRefGoogle Scholar
  29. 29.
    Weisberg LS, Kurnik PB, Kurnik BR (1993) Dopamine and renal blood flow in radiocontrastinduced nephropathy in humans. Renal Failure 15: 61–68PubMedCrossRefGoogle Scholar
  30. 30.
    Heyman SN, Brezis M (1996) The Renal Medulla: Life on the edge of hypoxia. The Third Annual Symposium on Applied Physiology of the peripheral circulation. 96:9Google Scholar
  31. 31.
    Heyman SN, Fuchs S, Brezis M (1995) The role of medullary ischemia in Acute Renal Failure. New Horizons 3(4):597–607PubMedGoogle Scholar
  32. 32.
    Barrett BJ, Parfrey PS (1994) Prevention of nephrotoxicity induced by radiocontrast agents. N Engl J Med 331:1449–1450PubMedCrossRefGoogle Scholar
  33. 33.
    Weinstein JM, Heyman S, Brezis M (1992) Potential deleterious effect of furosemide in radiocontrast nephropathy. Nephron 62(4):413–415PubMedCrossRefGoogle Scholar
  34. 34.
    Kahlmater G, Dahlager JI (1984) Aminoglycoside toxicity — a review of clinical studies pub1 i shed between 1975 and 1982. J Antimicrob Chemother 13 [Suppl A] :9–22Google Scholar
  35. 35.
    Butler WT, Bennett JE, Alling DW et al (1964) Nephrotoxicity of amphotericin B, early and late events in 81 patients. Ann Intern Med 61:175–187PubMedGoogle Scholar
  36. 36.
    Anderson WP, Korner PI, Selig SE (1981) Mechanisms involved in the renal responses to intravenous and renal artery infusions of noradrenaline in conscious dogs. J Physiol 321:21–30PubMedGoogle Scholar
  37. 37.
    Zhang H, Smail N, Cabral A et al (1997) Effects of norepinephrine on regional blood flow and oxygen extraction capabilities during endotoxic shock. Am J Resp Crit Care Med 155: 1965–1971PubMedGoogle Scholar
  38. 38.
    Martin C, Eon B, Saux P et al (1990) Renal effects of norepinephrine used to treat septic shock patients. Crit Care Med 18:282–285CrossRefGoogle Scholar
  39. 39.
    Desjars P, Pinaud M, Bugnon D, Tasseau F (1990) Norepinephrine therapy has no deleterious renal effects in human septic shock. Crit Care Med 18:1048–1049CrossRefGoogle Scholar
  40. 40.
    Yeh BP, Tomki DJ, Stacy WK et al (1975) Factors influencing sodium and water excretion in uremic man. Kidney Int 7:103–110PubMedCrossRefGoogle Scholar
  41. 41.
    Pastan S, Bailey J (1998) Dialysis therapy. N Engl J Med 338:1428–1437PubMedCrossRefGoogle Scholar
  42. 42.
    Yagi N, Paganini EP (1998) Acute dialysis and continuous renal replacement: Emergence of a new technology involving the nephrologist in the intensive care setting. Seminars Nephrol 117:306–320Google Scholar
  43. 43.
    Himmelfarb J, Tolkoff-Rubin N, Chandran P et al (1998) A multicenter comparison of dialysis membranes in the treatment of acute renal failure requiring dialysis. J Amer Soc Nephrol 9:257–266Google Scholar
  44. 44.
    Hakim RM, Held PJ, Stannard DC et al (1996) Effect of the dialysis membrane on mortality of chronic hemodialysis patients. Kidney Int 50:566–570PubMedCrossRefGoogle Scholar
  45. 45.
    Carreno MP, Stuard S, Bonomini M et al (1996) Cell-associated adhesion molecules as early markers of bioincompatibility. Nephrol Dial Transplant 11:2248–2257PubMedCrossRefGoogle Scholar
  46. 46.
    Thylen P, Fernvik E, Lundahl J et al (1996) Modulation of CD 11 b/CD 18 on monocytes and granulocytes following hemodialysis membrane interaction in vitro. Internat J Artif Org 19: 156–163Google Scholar
  47. 47.
    Hatala R, Dinh TT, Cook DJ (1997) Single daily dosing of aminoglycosides in immunocompromised adults: a systematic review. Clin Infectious Dis 24:810–815CrossRefGoogle Scholar
  48. 48.
    Prins JM, Buller HR, Kuijper EJ et al (1993) Once versus thrice daily gentamicin in patients with serious infections. Lancet 341:335–339PubMedCrossRefGoogle Scholar
  49. 49.
    Walsh TJ, Hiemenz JW, Seibel NL et al (1998) Amphotericin B lipid complex for invasive fungal infections: Analysis of safety and efficacy in 556 cases. Clinical Infectious Diseases 26:1383–1396PubMedCrossRefGoogle Scholar
  50. 50.
    Schoffski P, Freund M, Wunder R et al (1998) Safety and toxicity of amphotericin B in glucose 5% or intralipid 20% in neutropenic patients with pneumonia or fever of unknown origin: randomised study. Brit Med J 317:379–384PubMedCrossRefGoogle Scholar
  51. 51.
    Kellum JA, Leblanc M, Angus DC et al (1998) Continuous vs. intermittent renal replacement therapy: Is there a difference in survival? (abstract). Crit Care Med 27:A63CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

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  • J. A. Kellum

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