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Updated: Dec 6, 2025
06:51
Multilevel Microdissection and Functional-Structural Profiling of Human Renal Arterial Branches
Published on: September 5, 2025
406
New strategies to optimize renal haemodynamics
Jonathan Suarez1,2, Laurence W Busse1,2
1Department of Medicine, Emory University.
Current Opinion in Critical Care
|October 12, 2020
Summary
Maintaining optimal mean arterial pressure (MAP) is crucial for renal function preservation. Understanding renal hemodynamics and employing targeted therapies can help prevent acute kidney injury (AKI) in shock patients.
Area of Science:
- Nephrology
- Critical Care Medicine
- Hemodynamics
Background:
- Acute kidney injury (AKI) is a frequent complication in patients experiencing organ failure during shock.
- Hemodynamic instability significantly contributes to the risk of AKI.
- Routine measurement of renal hemodynamics is not standard practice but could guide treatment.
Purpose of the Study:
- To review macrocirculatory and microcirculatory aspects of renal perfusion.
- To discuss novel methods for measuring renal blood flow.
- To explore therapeutic strategies for renal perfusion, including microcirculatory effects.
Main Methods:
- Review of existing literature on renal perfusion, hemodynamics, and AKI.
- Discussion of various methods for measuring macrocirculatory and microcirculatory renal blood flow.
- Analysis of therapeutic options impacting renal hemodynamics.
Main Results:
- Optimal mean arterial pressure (MAP) for renal function is likely between 60-80 mmHg.
- Renal outflow pressure (e.g., central venous pressure) is an important consideration.
- Vasopressors with specific microcirculatory effects may help mitigate heterogeneity; excessive catecholamines should be avoided.
- Angiotensin II and vasopressin show potential in improving glomerular flow.
- Bedside ultrasound, sublingual microscopy, and urinary oxygen measurement are viable techniques for assessing renal blood flow.
Conclusions:
- Avoiding hemodynamic instability is key to mitigating AKI risk in shock.
- Personalized blood pressure management, informed by understanding pathophysiology and measurement techniques, can help prevent AKI.
- Therapeutic strategies should consider renal-specific microcirculatory effects.
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