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Interconnected Organs: Exploring the Impact of Kidney-Lung Crosstalk in Critically Ill Neonates and Children

Michelle C Starr1, Stephen Gorga2, Katja M Gist3

  • 1Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana, USA.

Comprehensive Physiology
|December 20, 2025
PubMed

Insights

Acute kidney injury (AKI) and acute lung injury (ALI) are common in critically ill children. These conditions are linked and can worsen each other, impacting fluid balance and long-term outcomes.

Area of Science:

  • Pediatric Critical Care Medicine
  • Nephrology
  • Pulmonology

Background:

  • Acute kidney injury (AKI) and acute lung injury (ALI) frequently affect critically ill children, particularly neonates and those with cardiac disease.
  • These organ injuries are interconnected through molecular signaling and organ crosstalk, influencing each other's function.
  • A significant link exists between AKI and fluid balance disorders, creating a synergistic and bidirectional relationship.

Purpose of the Study:

  • To explore the complex interplay between AKI, ALI, and fluid balance in critically ill pediatric patients.
  • To highlight the bidirectional and synergistic relationship between AKI and fluid imbalance.
  • To discuss the impact of organ crosstalk and potential treatment strategies.

Main Methods:

  • Review of existing pediatric research on AKI and ALI.
  • Analysis of molecular signaling and cytokine involvement in organ crosstalk.
  • Examination of fluid management's role and impact on AKI and ALI.

Main Results:

  • Fluid accumulation exacerbates ALI by impairing gas exchange and worsens renal perfusion.
  • Organ crosstalk involves pro-inflammatory and anti-inflammatory cytokines, contributing to injury.
  • AKI in premature neonates increases the risk of bronchopulmonary dysplasia and chronic lung disease.

Conclusions:

  • AKI and ALI have detrimental effects in pediatric patients, with AKI posing long-term risks, especially for neonates.
  • Supportive treatments for ALI can inadvertently worsen renal perfusion, creating a cycle of organ dysfunction.
  • Further research is needed to develop interventions preventing or mitigating kidney and lung injuries in critically ill children.

Keywords:
AKIALIkidneylungorgan crosstalk

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