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Renal perfusion in sepsis: from macro- to microcirculation

par Post, Emiel;Kellum, John J.A.;Bellomo, Rinaldo;Vincent, Jean Louis
Référence Kidney international, 91, 1, page (45-60)
Publication Publié, 2017-01

Article révisé par les pairs

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Résumé :

The pathogenesis of sepsis-associated acute kidney injury is complex and likely involves perfusion alterations, a dysregulated inflammatory response, and bioenergetic derangements. Although global renal hypoperfusion has been the main target of therapeutic interventions, its role in the development of renal dysfunction in sepsis is controversial. The implications of renal hypoperfusion during sepsis probably extend beyond a simple decrease in glomerular filtration pressure, and targeting microvascular perfusion deficits to maintain tubular epithelial integrity and function may be equally important. In this review, we provide an overview of macro- and microcirculatory dysfunction in experimental and clinical sepsis and discuss relationships with kidney oxygenation, metabolism, inflammation, and function.