Renal perfusion in sepsis: from macro- to microcirculation

Area of Science:

• Nephrology
• Critical Care Medicine
• Pathophysiology

Background:

• Sepsis-associated acute kidney injury (AKI) pathogenesis is multifactorial.
• Global renal hypoperfusion is a debated contributor to sepsis-induced AKI.
• Microvascular dysfunction may significantly impact tubular integrity and function.

Purpose of the Study:

• To review macro- and microcirculatory dysfunction in experimental and clinical sepsis.
• To explore the relationship between circulatory changes and kidney function in sepsis.

Main Methods:

• Literature review of experimental and clinical studies on sepsis and AKI.
• Analysis of data on renal perfusion, oxygenation, metabolism, and inflammation.

Main Results:

• Renal hypoperfusion's role in sepsis-induced AKI is complex and controversial.
• Microvascular deficits are implicated in maintaining tubular epithelial integrity.
• Dysfunction extends beyond glomerular filtration pressure changes.

Conclusions:

• Understanding both macro- and microcirculatory alterations is key to sepsis-AKI management.
• Therapeutic strategies should consider microvascular perfusion to preserve kidney function.
• Further research is needed to elucidate the interplay of factors in sepsis-AKI.