Research progress on the pathogenesis of AKI complicated by ECMO.

IF 2.2 4区医学 Q2 UROLOGY & NEPHROLOGY

Clinical and Experimental Nephrology Pub Date : 2025-01-01 Epub Date: 2024-09-28 DOI:10.1007/s10157-024-02559-7

Keke Sun, Congcong Yao, Guowu Xu, Jinxiang Wang, Songtao Shou, Heng Jin

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引用次数: 0

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) stands as a pivotal intervention for patients grappling with cardiopulmonary insufficiency. However, alongside its therapeutic benefits, ECMO carries the risk of complications, with acute kidney injury (AKI) emerging as a significant concern. The precise pathophysiological underpinnings of AKI in the context of ECMO remain incompletely elucidated.

Methods: A comprehensive literature review was conducted to explore the epidemiology and pathophysiological mechanisms underlying the utilization of ECMO in the management of AKI.

Results: ECMO initiates a multifaceted cascade of inflammatory reactions, encompassing complement activation, endothelial dysfunction, white blood cell activation, and cytokine release. Furthermore, factors such as renal hypoperfusion, ischemia-reperfusion injury, hemolysis, and fluid overload exacerbate AKI. Specifically, veno-arterial ECMO (VA-ECMO) may directly induce renal hypoperfusion, whereas veno-venous ECMO (VV-ECMO) predominantly impacts pulmonary function, indirectly influencing renal function.

Conclusion: While ECMO offers significant therapeutic advantages, AKI persists as a potentially fatal complication. A thorough comprehension of the pathogenesis underlying ECMO-associated AKI is imperative for effective prevention and management strategies. Moreover, additional research is warranted to delineate the incidence of AKI secondary to ECMO and to refine clinical approaches accordingly.

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ECMO 并发 AKI 的发病机制研究进展。

背景：体外膜肺氧合（ECMO）是心肺功能不全患者的关键干预措施。然而，ECMO 在带来治疗益处的同时，也存在并发症的风险，其中急性肾损伤（AKI）是一个令人严重关切的问题。ECMO 引起急性肾损伤的确切病理生理学基础仍未完全阐明：方法：进行了全面的文献综述，以探讨使用 ECMO 治疗 AKI 的流行病学和病理生理学机制：结果：ECMO 引发了一连串多方面的炎症反应，包括补体激活、内皮功能障碍、白细胞激活和细胞因子释放。此外，肾脏低灌注、缺血再灌注损伤、溶血和液体超负荷等因素也会加重 AKI。具体而言，静脉-动脉 ECMO（VA-ECMO）可直接导致肾脏灌注不足，而静脉-静脉 ECMO（VV-ECMO）主要影响肺功能，间接影响肾功能：结论：虽然 ECMO 在治疗方面具有显著优势，但 AKI 仍是一种潜在的致命并发症。全面了解 ECMO 相关 AKI 的发病机制对于制定有效的预防和管理策略至关重要。此外，还需要开展更多研究，以确定 ECMO 继发 AKI 的发生率，并相应改进临床方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Nephrology UROLOGY & NEPHROLOGY-

CiteScore

4.10

自引率

4.30%

发文量

135

审稿时长

4-8 weeks

期刊介绍： Clinical and Experimental Nephrology is a peer-reviewed monthly journal, officially published by the Japanese Society of Nephrology (JSN) to provide an international forum for the discussion of research and issues relating to the study of nephrology. Out of respect for the founders of the JSN, the title of this journal uses the term “nephrology,” a word created and brought into use with the establishment of the JSN (Japanese Journal of Nephrology, Vol. 2, No. 1, 1960). The journal publishes articles on all aspects of nephrology, including basic, experimental, and clinical research, so as to share the latest research findings and ideas not only with members of the JSN, but with all researchers who wish to contribute to a better understanding of recent advances in nephrology. The journal is unique in that it introduces to an international readership original reports from Japan and also the clinical standards discussed and agreed by JSN.