Abstract：
:Acute kidney injury (AKI) is common in the setting of shock. Hemodynamic instability is a risk factor for the development of AKI, and pathophysiological mechanisms include loss of renal perfusion pressure and impaired microcirculation. Although restoration of mean arterial pressure (MAP) may mitigate the risk of AKI to some extent, evidence on this is conflicting. Also debatable is the optimal blood pressure needed to minimize the risk of kidney injury. A MAP of 65 mm Hg traditionally has been considered adequate to maintain renal perfusion pressure, and studies have failed to consistently show improved outcomes at higher levels of MAP. Therapeutic options to support renal perfusion consist of catecholamines, vasopressin, and angiotensin II. Although catecholamines are the most studied, they are associated with adverse events at higher doses, including AKI. Vasopressin and angiotensin II are noncatecholamine options to support blood pressure and may improve microcirculatory hemodynamics through unique mechanisms, including differential vasoconstriction of efferent and afferent arterioles within the nephron. Future areas of study include methods by which clinicians can measure renal blood flow in a macrocirculatory and microcirculatory way, a personalized approach to blood pressure management in septic shock using patient-specific measures of perfusion adequacy, and novel agents that may improve the microcirculation within the kidneys without causing adverse microcirculatory effects in other organs.
journal_name
Semin Nephroljournal_title
Seminars in nephrologyauthors
Busse LW,Ostermann Mdoi
10.1016/j.semnephrol.2019.06.006subject
Has Abstractpub_date
2019-09-01 00:00:00pages
462-472issue
5eissn
0270-9295issn
1558-4488pii
S0270-9295(19)30059-2journal_volume
39pub_type
杂志文章,评审abstract：:Kidney function declines with age in association with the development of age-associated glomerulosclerosis. The well-established structural and functional changes with age are reviewed briefly. The modification of aging pathology by calorie restriction is discussed. The role of the podocyte as a critical cell in the a...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2009.07.012
更新日期：2009-11-01 00:00:00
abstract：:As kidney function declines, chronic kidney disease (CKD) becomes an increasingly systemic disorder. Most patients with CKD eventually develop subclinical or clinical abnormalities in bone and mineral metabolism. Recent observational and basic scientific studies have led to a new emphasis on the changes in phosphorus ...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2009.01.002
更新日期：2009-03-01 00:00:00
abstract：:Red cell production in chronic kidney disease is usually too low to maintain a normal haemoglobin, and thus anaemia develops in a large proportion of patients. The ability to stimulate erythropoiesis in the bone marrow by the use of therapeutic agents has only been possible in the last 20 years, initially with recombi...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2006.05.008
更新日期：2006-07-01 00:00:00
abstract：:The catecholamines dopamine and norepinephrine, play a central role in the regulation of sodium homeostasis and blood pressure. Dopamine inhibits tubular Na+, K(+)-ATPase activity and increases sodium excretion. Norepinephrine stimulates Na+, K(+)-ATPase activity and decreases urinary sodium excretion. The signaling p...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：
更新日期：1993-01-01 00:00:00
abstract：:IgA nephropathy (IgAN), a common primary glomerulonephritis worldwide, is associated with a substantial risk of progression to end-stage renal failure. The disease runs a highly variable clinical course with frequent involvement of tubulointerstitial damage. A subgroup of IgAN with proximal tubular epithelial cells (P...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2018.05.018
更新日期：2018-09-01 00:00:00
abstract：:Preeclampsia is a 2-stage disorder. Stage 1 is decreased placental perfusion and generates stage 2 of the disorder, the maternal syndrome characteristic of preeclampsia. How the 2 stages are linked has been a topic of intense investigation for many years. One candidate phenomenon, which includes many other suggested l...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/s0270-9295(04)00126-3
更新日期：2004-11-01 00:00:00
abstract：:The search for an endogenous digitalis has led to the identification of the cardenolides ouabain and digoxin and the bufadienolide marinobufagenin in mammalian tissues and biological fluids. Ouabain's release from adrenal glands is under the control of epinephrine and angiotensin II; hence, its blood concentration cha...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2005.03.010
更新日期：2005-09-01 00:00:00
abstract：:Antineutrophil cytoplasmic autoantibodies (ANCA) are the likely cause for necrotizing small-vessel vasculitis and crescentic glomerulonephritis. Unlike other forms of crescentic glomerulonephritis induced by immune complexes or anti-glomerular basement membrane antibodies that have conspicuous vessel wall immunoglobul...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2013.08.006
更新日期：2013-11-01 00:00:00
abstract：:Prolonged hyperuricemia is associated with the development of hypertension, renal arteriolosclerosis, glomerulosclerosis, and tubulointerstitial injury. It confers a greater risk than proteinuria for developing chronic renal disease and is associated with the development of hypertension. Mild chronic hyperuricemia wit...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2004.09.004
更新日期：2005-01-01 00:00:00
abstract：:A number of conditions can contribute to the development of the anemia that inevitably occurs with end-stage renal disease. The primary ones are decreased production of erythropoietin (EPO), decreased response to EPO by the bone marrow, and shortened red cell survival. Dialysis improves hematocrit levels by reducing p...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：
更新日期：1989-03-01 00:00:00
abstract：:A number of organic acids including phenols are accumulated in plasma of uremic patients because of reduced renal clearance. Some of them account for uremic problems such as reduced drug binding. Protein-bound organic acids such as hippuric acid, indoxyl sulfate, and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：
更新日期：1996-05-01 00:00:00
abstract：:Blood pressure increases with age in all US population groups that have been studies, but does so faster in African Americans. Evidence from extensive microscopic renal vascular studies at autopsy supports the view that blood pressure increases with age because of progressive fibroplasia of renal interlobular arteries...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：
更新日期：1996-03-01 00:00:00
abstract：:Care of patients with type 1 diabetes (T1D) has changed during the past 30 years. Tools to control hyperglycemia have improved and it was shown that improvement in glycemic control diminished the risk of late diabetic complications, including nephropathy. Moreover, in patients with impaired renal function, aggressive ...
journal_title：Seminars in nephrology
pub_type： 杂志文章
doi：10.1016/j.semnephrol.2012.07.002
更新日期：2012-09-01 00:00:00
abstract：:In aggregate, the evidence reviewed here supports a very important role for PDGF expression and action at local glomerular and interstitial sites in human kidney development and disease. PDGF delivered by platelets, or produced by endogenous cells of the kidney is capable of stimulating responses including proliferati...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：
更新日期：1993-01-01 00:00:00
abstract：:Amiloride is a prototypic inhibitor of epithelial sodium channels. Rapid progress has been made in our understanding of the structure of the sodium channel and related cation-selective channels. This work, coupled with experiments examining how selected sodium channel mutations affect amiloride binding, provides criti...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：
更新日期：1999-11-01 00:00:00
abstract：:A review is presented of 164 nephrotic patients who were older than 60 years at the onset of their nephrotic syndrome, together with a review of more than 1,000 patients from the literature. The nephrotic syndrome in elderly patients is as common as in younger adults, but is often misdiagnosed as "heart failure" by pr...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：
更新日期：1996-07-01 00:00:00
abstract：:Despite intensive research over the past three decades, the events leading to pathogenic autoantibody production and immune deposit formation in individuals with systemic lupus erythematosus continues to be debated. The controversy is fueled by the clinical observations that individual patients with lupus have variabl...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：
更新日期：1999-01-01 00:00:00
abstract：:At the present time, knowledge of the structure of the proton-translocating ATPase responsible for urinary acidification is far from complete. Key issues awaiting resolution are full definition of subunit structure and an understanding of the interactions among functional domains of this complex hetero-oligomer. Such ...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：
更新日期：1990-03-01 00:00:00
abstract：:Cytomegalovirus (CMV), human herpes virus (HHV)-6, and HHV-7 are ubiquitous β-herpesviruses that can cause opportunistic infection and disease in kidney transplant recipients. Active CMV infection and disease are associated with acute allograft failure and death, and HHV-6 and HHV-7 replication are associated with CMV...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2016.05.012
更新日期：2016-09-01 00:00:00
abstract：:There are several published series of pregnancy in patients with nonimmunoglobulin A mesangial proliferative glomerulonephritis (most of whom have thin basement membrane nephropathy [TBMN]). The aim of the present study was to review the maternal and fetal outcomes of pregnancy in women with TBMN. The medical and obst...
journal_title：Seminars in nephrology
pub_type： 杂志文章
doi：10.1016/j.semnephrol.2005.01.011
更新日期：2005-05-01 00:00:00
abstract：:Stephen Hales was the first to measure blood pressure directly in the horse (1733), and the definitive studies on human nephrins by Richard Bright followed much later (1836). The relation between high blood pressure and renal disease was established by Mahomed (1872). The discovery of renin and its possible link with ...
journal_title：Seminars in nephrology
pub_type： 历史文章,杂志文章
doi：
更新日期：2000-09-01 00:00:00
abstract：:Necrosis is the predominant form of regulated cell death in acute kidney injury (AKI) and represents results in the formation of casts that appear in the urine sedimentation, referred to as muddy brown casts, which are part of the diagnosis of AKI. Pathologists referred to this typical feature as acute tubular necrosi...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2016.03.002
更新日期：2016-05-01 00:00:00
abstract：:Acute renal failure (ARF) is an important clinical syndrome. Despite the frequent occurrence of ARF, nephrologists have not made major therapeutic inroads in the treatment or prevention of ARF. This article will speculate as to why it has been so difficult to gain a substantial foothold in the ongoing battle against A...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：
更新日期：1998-09-01 00:00:00
abstract：:The renal tubular epithelium maintains different sets of transport proteins in plasma membrane domains facing the lumenal and mucosal fluids and limits diffusion between these two compartments. This asymmetry is generated by directing transporters to the appropriate membrane domain, a process that requires both an int...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：
更新日期：1998-03-01 00:00:00
abstract：:Peritoneal dialysis (PD) may be a feasible, safe, and complementary alternative to hemodialysis not only in the chronic setting, but also in the acute setting. It previously was widely accepted for acute kidney injury (AKI) treatment, but its practice decreased in favor of other types of extracorporeal therapies. The ...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2016.10.011
更新日期：2017-01-01 00:00:00
abstract：:IgA nephropathy is one of the most common causes of glomerulonephritis in the world and is characterized histologically by the deposition of polymeric forms of IgA within the mesangium and in some cases along the glomerular capillary wall.(1) Proliferative and crescenteric forms of IgA are associated with nephrotic ra...
journal_title：Seminars in nephrology
pub_type： 杂志文章
doi：10.1016/j.semnephrol.2004.01.006
更新日期：2004-05-01 00:00:00
abstract：:Vascular remodeling and hypertrophy-hyperplasia of the heart and kidney are the hallmarks of hypertensions, being involved in the long-term maintenance of elevated blood pressure and the development of cardiovascular and renal hypertension. Both augmented proliferation and unscheduled programmed cell death (apoptosis)...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1053/snep.2002.2002.30434
更新日期：2002-03-01 00:00:00
abstract：:One of the most important and lethal effects of animal venoms is nephrotoxicity. In Latin America, severe acute kidney injury has been reported after accidents with poisonous arthropods such as bees, caterpillars of the genus Lonomia, and spiders of the genus Loxosceles. In this article the characteristics of these ve...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2008.04.006
更新日期：2008-07-01 00:00:00
abstract：:Cigarette smoking (CS) has been associated with augmented progression of nephropathies responsible for the 4 major causes of end-stage renal disease (ESRD) in the United States. CS has well-described ways by which it causes tissue injury in other organ systems and the mechanisms by which it adversely affects nephropat...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/s0270-9295(03)00037-8
更新日期：2003-05-01 00:00:00
abstract：:Macrophages have long been regarded as classic mediators of innate immunity because of their production of proinflammatory cytokines and their ability to induce apoptotic cell death. As a result of such activities and the detrimental long-term effect of kidney inflammation, macrophages principally have been regarded a...
journal_title：Seminars in nephrology
pub_type： 杂志文章,评审
doi：10.1016/j.semnephrol.2010.03.011
更新日期：2010-05-01 00:00:00
