Kidney Injury Following Cardiac Surgery: A Review of Our Current Understanding.

IF 2.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Christine-Elena Kamla, Melanie Meersch-Dini, Lilian Monteiro Pereira Palma
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引用次数: 0

Abstract

Around one-quarter of all patients undergoing cardiac procedures, particularly those on cardiopulmonary bypass, develop cardiac surgery-associated acute kidney injury (CSA-AKI). This complication increases the risk of several serious morbidities and of mortality, representing a significant burden for both patients and the healthcare system. Patients with diminished kidney function before surgery, such as those with chronic kidney disease, are at heightened risk of developing CSA-AKI and have poorer outcomes than patients without preexisting kidney injury who develop CSA-AKI. Several mechanisms are involved in the development of CSA-AKI; injury is primarily thought to result from an amplification loop of inflammation and cell death, with complement and immune system activation, cardiopulmonary bypass, and ischemia-reperfusion injury all contributing to pathogenesis. At present there are no effective, targeted pharmacological therapies for the prevention or treatment of CSA-AKI, although several preclinical trials have shown promise, and clinical trials are under way. Progress in the understanding of the complex pathophysiology of CSA-AKI is needed to improve the development of successful strategies for its prevention, management, and treatment. In this review, we outline our current understanding of CSA-AKI development and management strategies and discuss potential future therapeutic targets under investigation.

心脏手术后肾损伤:回顾我们目前的认识。
大约四分之一接受心脏手术的患者,特别是那些体外循环的患者,会发生心脏手术相关的急性肾损伤(CSA-AKI)。这种并发症增加了几种严重发病率和死亡率的风险,对患者和卫生保健系统都构成了重大负担。术前肾功能减退的患者,如患有慢性肾脏疾病的患者,发生CSA-AKI的风险较高,并且与没有既往肾损伤的患者相比,发生CSA-AKI的预后较差。CSA-AKI的发展涉及多种机制;损伤主要被认为是由炎症和细胞死亡的放大循环引起的,补体和免疫系统激活、体外循环和缺血再灌注损伤都有助于发病。目前还没有有效的靶向药物治疗来预防或治疗CSA-AKI,尽管一些临床前试验显示出了希望,临床试验正在进行中。需要对CSA-AKI复杂的病理生理学的理解取得进展,以改善其预防、管理和治疗的成功策略的发展。在这篇综述中,我们概述了目前对CSA-AKI发展和管理策略的理解,并讨论了正在研究的潜在未来治疗靶点。
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来源期刊
CiteScore
6.70
自引率
3.30%
发文量
38
审稿时长
>12 weeks
期刊介绍: Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.
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