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[Lung and kidney failure. Pathogenesis, interactions, and therapy]

S John1, C Willam2

  • 1Medizinische Klinik 4, Universität Erlangen-Nürnberg, Erlangen, Deutschland. stefan.john@uk-erlangen.de.

Medizinische Klinik, Intensivmedizin Und Notfallmedizin
|February 14, 2015
PubMed
Abstract

Insights

Multiple organ failure (MOF) often affects lungs and kidneys, leading to high mortality. Understanding the kidney-lung crosstalk and optimizing organ support therapies are crucial for improving patient outcomes in critical care.

Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Pulmonology

Background:

  • Multiple organ failure (MOF) frequently impacts the lungs (acute respiratory distress syndrome, ARDS) and kidneys (kidney failure), carrying a high mortality rate.
  • The precise mechanisms of MOF are not fully understood, but shared pathophysiological pathways and bidirectional harm (kidney-lung crosstalk) between these organs are implicated.
  • Inflammatory signals and volume overload contributing to edema formation are key factors in this crosstalk.

Purpose of the Study:

  • To explore the complex interactions between lung and kidney failure in the context of multiple organ failure.
  • To review the potential for organ replacement therapies to exacerbate or mitigate injury to the contralateral organ.
  • To highlight emerging therapeutic strategies aimed at reducing iatrogenic injury during organ support.

Main Methods:

  • Review of existing literature on multiple organ failure, kidney-lung crosstalk, and organ replacement therapies.
  • Analysis of the impact of mechanical ventilation and renal replacement therapy on lung and kidney function, respectively.
  • Discussion of novel extracorporeal techniques for organ support.

Main Results:

  • Organ replacement therapies, while life-saving, can induce further injury (e.g., ventilator trauma, dialyte trauma).
  • Renal replacement therapy can offer benefits to lung injury by correcting fluid and acid-base balance.
  • Emerging technologies like low-flow extracorporeal CO2 removal integrated with renal replacement platforms show promise in reducing ventilator-induced lung injury.

Conclusions:

  • The kidney-lung axis plays a critical role in the progression of multiple organ failure.
  • Careful consideration of organ replacement therapies is necessary to minimize iatrogenic harm and leverage potential benefits.
  • Advancements in extracorporeal therapies offer new avenues for managing critical illness and improving outcomes in patients with MOF.
Keywords:
ARDS, humanAcute kidney injuryExtracorporeal CO2-eliminationMechanical ventilationRenal replacement therapy

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