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Kidney-Lung Crosstalk in Acute Nephrologic Involvement: Mechanisms, Complement Activation, and Implications for
Giuliana Martino1, Francesca Tinti2, Marco Alfonso Perrone3
1Nephrology and Dialysis Unit, University Hospital Tor Vergata, 00133 Rome, Italy.
Life (Basel, Switzerland)
|February 27, 2026
Summary
Acute kidney injury (AKI) is a systemic disease affecting multiple organs. Early kidney-lung interactions are clinically relevant, even in mild AKI, highlighting the need for integrated organ assessment in nephrology.
Area of Science:
- Nephrology
- Pulmonology
- Immunology
Background:
- Acute kidney injury (AKI) is a systemic syndrome causing remote organ dysfunction.
- Kidney-lung crosstalk, mediated by the heart, is a key interorgan communication pathway in AKI.
- A gut-lung-kidney axis and complement activation are implicated in multiorgan damage.
Purpose of the Study:
- To review literature on kidney-lung interactions and complement activation in AKI.
- To present real-world data on pulmonary involvement in non-intensive care unit (ICU) AKI patients.
- To emphasize AKI as a systemic disease from early stages.
Main Methods:
- Bibliographic search of PubMed, Scopus, and Web of Science for kidney-lung interactions and complement activation in AKI.
- Analysis of 186 consecutive non-ICU AKI patients.
- Assessment of pulmonary involvement at hospital admission and AKI staging.
Main Results:
- Pulmonary involvement was present in 63% of hospitalized AKI patients.
- Mild AKI (Stage 1) showed significant association with pulmonary involvement.
- Kidney-lung interactions are evident even in early and non-critical AKI.
Conclusions:
- AKI is a systemic disease from its earliest stages, involving significant kidney-lung crosstalk.
- Pulmonary involvement in AKI is common and clinically relevant outside critical care settings.
- Integrated organ assessment is crucial in routine nephrology, considering complement activation's role.
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