Lung-Kidney Cross-Talk in the Critically Ill Patient

Am J Respir Crit Care Med. 2016 Aug 15;194(4):402-14. doi: 10.1164/rccm.201602-0420CP.


Discoveries have emerged highlighting the complex nature of the interorgan cross-talk between the kidney and the lung. Vascular rigidity, neurohormonal activation, tissue hypoxia, and abnormal immune cell signaling have been identified as common pathways leading to the development and progression of chronic kidney disease. However, our understanding of the causal relationships between lung injury and kidney injury is not precise. This review discusses a number of features and mechanisms of renal dysfunction in pulmonary disorders in relation to respiratory acidosis, impaired gas exchange, systemic congestion, respiratory support/replacement therapies, and other issues relevant to the clinical care of these patients. Biotrauma due to injurious ventilatory strategies can lead to the release of mediators into the lung, which may then translocate into the systemic circulation and cause end-organ dysfunction, including renal dysfunction. Right ventricular dysfunction and congestive states may contribute to alterations of renal perfusion and oxygenation, leading to diuretic resistance and recurrent hospitalization. In patients with concomitant respiratory failure, noninvasive ventilation represents a promising treatment option for the correction of impaired renal microcirculation and endothelial dysfunction. In patients requiring extracorporeal membrane oxygenation, short- and long-term monitoring of kidney function is warranted, as they are at highest risk of developing acute kidney injury and fluid overload.

Keywords: acute kidney injury; extracorporeal membrane oxygenation; lung injury; mechanical ventilation; noninvasive ventilation.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / pathology
  • Acute Kidney Injury / physiopathology*
  • Acute Kidney Injury / therapy
  • Comorbidity
  • Critical Illness / therapy
  • Extracorporeal Membrane Oxygenation / adverse effects
  • Extracorporeal Membrane Oxygenation / methods
  • Extracorporeal Membrane Oxygenation / statistics & numerical data
  • Humans
  • Lung Injury / pathology
  • Lung Injury / physiopathology*
  • Lung Injury / therapy
  • Multiple Organ Failure*
  • Noninvasive Ventilation / adverse effects
  • Noninvasive Ventilation / methods
  • Noninvasive Ventilation / statistics & numerical data
  • Respiration, Artificial* / adverse effects
  • Respiration, Artificial* / methods
  • Respiration, Artificial* / statistics & numerical data
  • Respiratory Insufficiency / pathology
  • Respiratory Insufficiency / physiopathology*
  • Respiratory Insufficiency / therapy