scholarly journals Chess Not Checkers: Complexities Within the Myeloid Response to the Acute Kidney Injury Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
William T. Nash ◽  
Mark D. Okusa
Keyword(s):  
Acute Kidney Injury ◽  
Immune Responses ◽  
Kidney Injury ◽  
Myeloid Cell ◽  
Immune Dysregulation ◽  
Clear Understanding ◽  
Valuable Insight ◽  
Cell Dynamics ◽  
Dynamic Population ◽  
Insight Into

Immune dysregulation in acute kidney injury (AKI) is an area of intense interest which promises to enhance our understanding of the disease and how to manage it. Macrophages are a heterogeneous and dynamic population of immune cells that carry out multiple functions in tissue, ranging from maintenance to inflammation. As key sentinels of their environment and the major immune population in the uninjured kidney, macrophages are poised to play an important role in the establishment and pathogenesis of AKI. These cells have a profound capacity to orchestrate downstream immune responses and likely participate in skewing the kidney environment toward either pathogenic inflammation or injury resolution. A clear understanding of macrophage and myeloid cell dynamics in the development of AKI will provide valuable insight into disease pathogenesis and options for intervention. This review considers evidence in the literature that speaks to the role and regulation of macrophages and myeloid cells in AKI. We also highlight barriers or knowledge gaps that need to be addressed as the field advances.

scholarly journals A Porthole over AKI: Cell Dynamics in Damage and Repair

Nephron ◽  
2020 ◽  
Vol 144 (12) ◽  
pp. 650-654
Author(s):  
Luca Bordoni ◽  
Donato Sardella ◽  
Ina Maria Schiessl
Keyword(s):  
Acute Kidney Injury ◽  
Renal Cell ◽  
Kidney Injury ◽  
Cell Types ◽  
Cell Interactions ◽  
Intravital Imaging ◽  
Cell Dynamics ◽  
Powerful Technique ◽  
Increased Risk ◽  
Cell Crosstalk

Acute kidney injury (AKI) is associated with an increased risk of CKD. Injury-induced multifaceted renal cell-to-cell crosstalk can either lead to successful self-repair or chronic fibrosis and inflammation. In this mini-review, we will discuss critical renal cell types acting as victims or executioners in AKI pathology and introduce intravital imaging as a powerful technique to further dissect these cell-to-cell interactions.

scholarly journals Dismembering organisation: The coordination of algorithmic work in healthcare

2020 ◽  
Vol 68 (4) ◽  
pp. 546-571
Author(s):  
Simon Bailey ◽  
Dean Pierides ◽  
Adam Brisley ◽  
Clara Weisshaar ◽  
Tom Blakeman
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Human Experience ◽  
Ethnographic Study ◽  
Care Work ◽  
Healthcare Settings ◽  
Expected Performance ◽  
Sociological Literature ◽  
Insight Into

Algorithms are increasingly being adopted in healthcare settings, promising increased safety, productivity and efficiency. The growing sociological literature on algorithms in healthcare shares an assumption that algorithms are introduced to ‘support’ decisions within an interactive order that is predominantly human-oriented. This article presents a different argument, calling attention to the manner in which organisations can end up introducing a non-negotiable disjuncture between human-initiated care work and work that supports algorithms, which the authors call algorithmic work. Drawing on an ethnographic study, the authors describe how two hospitals in England implemented an Acute Kidney Injury (AKI) algorithm and analyse ‘interruptions’ to the algorithm’s expected performance. When the coordination of algorithmic work occludes care work, the study finds a ‘dismembered’ organisation that is algorithmically-oriented rather than human-oriented. In the discussion, the authors examine the consequences of coordinating human and non-human work in each hospital and conclude by urging sociologists of organisation to attend to the importance of the formal in algorithmic work. As the use of algorithms becomes widespread, the analysis provides insight into how organisations outside of healthcare can also end up severing tasks from human experience when algorithmic automation is introduced.

scholarly journals Toll-like Receptor 7 Contributes to Inflammation, Organ Injury, and Mortality in Murine Sepsis

2019 ◽  
Vol 131 (1) ◽  
pp. 105-118 ◽  
Author(s):  
Wenling Jian ◽  
Lili Gu ◽  
Brittney Williams ◽  
Yan Feng ◽  
Wei Chao ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Immune Responses ◽  
Knockout Mice ◽  
Cecal Ligation ◽  
Kidney Injury ◽  
Innate Immune ◽  
Organ Injury ◽  
Innate Immune Responses ◽  
Toll Like Receptor ◽  
Wild Type

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Sepsis remains a critical illness with high mortality. The authors have recently reported that mouse plasma RNA concentrations are markedly increased during sepsis and closely associated with its severity. Toll-like receptor 7, originally identified as the sensor for single-stranded RNA virus, also mediates host extracellular RNA-induced innate immune responses in vitro and in vivo. Here, the authors hypothesize that innate immune signaling via Toll-like receptor 7 contributes to inflammatory response, organ injury, and mortality during polymicrobial sepsis. Methods Sepsis was created by (1) cecal ligation and puncture or (2) stool slurry peritoneal injection. Wild-type and Toll-like receptor 7 knockout mice, both in C57BL/6J background, were used. The following endpoints were measured: mortality, acute kidney injury biomarkers, plasma and peritoneal cytokines, blood bacterial loading, peritoneal leukocyte counts, and neutrophil phagocytic function. Results The 11-day overall mortality was 81% in wild-type mice and 48% in Toll-like receptor 7 knockout mice after cecal ligation and puncture (N = 27 per group, P = 0.0031). Compared with wild-type septic mice, Toll-like receptor 7 knockout septic mice also had lower sepsis severity, attenuated plasma cytokine storm (wild-type vs. Toll-like receptor 7 knockout, interleukin-6: 43.2 [24.5, 162.7] vs. 4.4 [3.1, 12.0] ng/ml, P = 0.003) and peritoneal inflammation, alleviated acute kidney injury (wild-type vs. Toll-like receptor 7 knockout, neutrophil gelatinase-associated lipocalin: 307 ± 184 vs.139 ± 41-fold, P = 0.0364; kidney injury molecule-1: 40 [16, 49] vs.13 [4, 223]-fold, P = 0.0704), lower bacterial loading, and enhanced leukocyte peritoneal recruitment and phagocytic activities at 24 h. Moreover, stool slurry from wild-type and Toll-like receptor 7 knockout mice resulted in similar level of sepsis severity, peritoneal cytokines, and leukocyte recruitment in wild-type animals after peritoneal injection. Conclusions Toll-like receptor 7 plays an important role in the pathogenesis of polymicrobial sepsis by mediating host innate immune responses and contributes to acute kidney injury and mortality.

Drug-Induced Kidney Disease Associated With Selected Antibiotics

2020 ◽  
Vol 35 (5) ◽  
pp. 225-229
Author(s):  
Alexia S. Alvarez ◽  
Oluseyi Oyerinde ◽  
Justin P. Reinert
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Older People ◽  
Hospital Costs ◽  
Kidney Injury ◽  
Clear Understanding ◽  
First Line ◽  
Drug Induced ◽  
Improved Outcomes ◽  
Hospital Stays

Structural and functional degeneration of the kidneys occur as the human body ages, making oler people especially susceptible to the consequences of acute kidney injury. Furthermore, the use of nephrotoxic agents, combined with the increased incidence of acute kidney injury and likelihood of an intensive-care unit admission, makes geriatric patients prone to develop drug-induced kidney disease. Vancomycin is routinely used as the first-line treatment for methicillin-resistant Staphylococcus aureus, but is known to be nephrotoxic; studies have shown that an early switch from vancomycin to alternatives does not necessarily prevent renal insult. Therefore, we aim to discuss the mechanisms of drug-induced kidney disease with regard to vancomycin, daptomycin, and ceftaroline and to provide insight as to their safety profiles with regard to older people. A clear understanding of this topic will aid clinicians in selecting drug therapy and may lead to shortened hospital stays, lower hospital costs, and improved outcomes of critically ill older people.

COVID-19 aus Sicht des Nephrologen

2020 ◽  
Vol 145 (15) ◽  
pp. 1068-1073
Author(s):  
Martin Kann ◽  
Thomas Benzing
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Transplantation ◽  
Current Knowledge ◽  
Early Stage ◽  
Kidney Tissue ◽  
Kidney Injury ◽  
Chronic Hemodialysis ◽  
Initial Presentation ◽  
Proximal Tubular ◽  
Insight Into

AbstractIncreasing insight into the clinical phenotype and mechanisms of SARS-CoV-2 infections and COVID-19 has identified damage of the kidneys as a key player in the course of the disease. This manuscript summarizes the current knowledge on direct viral infection of kidney tissue, proteinuria and acute kidney injury in COVID-19, and management of patients on chronic dialysis as well as after kidney transplantation. Direct infection of podocytes and proximal tubular cells by SARS-CoV-2 has been confirmed and results in proteinuria and hematuria at an early stage of COVID-19. In this context, any kidney affection is a predictor of worse outcomes among COVID-19 patients irrespective of the initial presentation and increases the risk of acute kidney injury. Specific therapies for kidney damage and acute kidney injury within COVID-19 that could be generally recommended are currently lacking. Patients on chronic hemodialysis in particular are at risk for contracting SARS-CoV-2 infections as indicated by outbreaks and super-spreading events in hemodialysis facilities. Immunosuppressive therapy after kidney transplantation needs to be adapted upon diagnosis of COVID-19 depending on the severity of the initial presentation.

scholarly journals Tools of the Trade: How Do You Perform and Interpret an Exercise Test?

2019 ◽  
Vol 18 (2) ◽  
pp. 47-55
Author(s):  
Franz P. Rischard ◽  
Barry A. Borlaug
Keyword(s):  
Cardiopulmonary Exercise Testing ◽  
Response To Therapy ◽  
Pulmonary Vascular Disease ◽  
Clear Understanding ◽  
Valuable Insight ◽  
Adaptation To Stress ◽  
The Individual ◽  
Cardiopulmonary System ◽  
Insight Into ◽  
Minute Walk

Background: Most pulmonary vascular disease (PVD) is poorly modifiable and incurable even with effective therapy. Therefore, adaptation to stress, the reserve of the cardiopulmonary system, is important for assessment of patient function and prognosis. Methods that assess the adaptation to stress, especially exercise, provide valuable insight into diagnosis, prognosis, and response to therapy. Implications for Clinicians: We provide a comprehensive review of the indications, methodology, and interpretation, as well as practical information of the forms of provocative testing in PVD. We include 6-minute walk testing, noninvasive cardiopulmonary exercise testing (CPET), invasive CPET, and additional forms, including volume loading. Conclusions: Through a clear understanding of the methodology in the assessment of PVD, the clinician can determine which of these “tools of the trade” are best suited to the individual patient and situation.

Management of oliguria and acute kidney injury in the critically ill

2016 ◽  
Author(s):  
Mohammed Ahmed ◽  
Sean M. Bagshaw
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Functional Decline ◽  
Kidney Injury ◽  
Clinical Problem ◽  
Therapeutic Interventions ◽  
Clear Understanding ◽  
Related Factors

Acute kidney injury (AKI) remains a challenging clinical problem for clinicians caring for critically-ill patients due largely to the paucity of specific therapeutic interventions aimed at mitigating poor outcome. Those patients most at risk for the development of AKI can often be identified by an assessment of demographic, clinical, diagnostic, and procedure-related factors couple with early and intensive bedside monitoring. Importantly, critically-ill patients are often exposed to multiple discrete risks that can accumulate during their course that can negatively impact not only the duration and severity of AKI, but also probability of recovery, and long-term functional decline and risk of development of chronic kidney disease. All critically-ill patients at risk of or with milder forms of AKI should have support individualized. A clear understanding of the scope, complexity, and general principals of prevention and management of AKI are indispensable in the care of these patients and will discussed in this chapter.

scholarly journals Acute Kidney Injury in COVID-19

2021 ◽  
Vol 22 (15) ◽  
pp. 8081
Author(s):  
Marta Głowacka ◽  
Sara Lipka ◽  
Ewelina Młynarska ◽  
Beata Franczyk ◽  
Jacek Rysz
Keyword(s):  
Acute Kidney Injury ◽  
Strong Association ◽  
Kidney Injury ◽  
Respiratory Illness ◽  
Angiotensin Converting Enzyme 2 ◽  
Tubular Cells ◽  
Collapsing Glomerulopathy ◽  
Proximal Tubular ◽  
Insight Into

COVID-19 is mainly considered a respiratory illness, but since SARS-CoV-2 uses the angiotensin converting enzyme 2 receptor (ACE2) to enter human cells, the kidney is also a target of the viral infection. Acute kidney injury (AKI) is the most alarming condition in COVID-19 patients. Recent studies have confirmed the direct entry of SARS-CoV-2 into the renal cells, namely podocytes and proximal tubular cells, but this is not the only pathomechanism of kidney damage. Hypovolemia, cytokine storm and collapsing glomerulopathy also play an important role. An increasing number of papers suggest a strong association between AKI development and higher mortality in COVID-19 patients, hence our interest in the matter. Although knowledge about the role of kidneys in SARS-CoV-2 infection is changing dynamically and is yet to be fully investigated, we present an insight into the possible pathomechanisms of AKI in COVID-19, its clinical features, risk factors, impact on hospitalization and possible ways for its management via renal replacement therapy.

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