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Pathophysiology of Acute Kidney Injury in Critical Illness: A Narrative Review

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Acute kidney injury (AKI) is a syndrome that entails a rapid decline in kidney function with or without injury. The consequences of AKI among acutely ill patients are dire and lead to higher mortality, morbidity, and healthcare cost. To prevent AKI and its short and long‐term repercussions, understanding its pathophysiology is essential. Depending on the baseline kidney histology and function reserves, the number of kidney insults, and the intensity of each insult, the clinical presentation of AKI may differ. While many factors are capable of inducing renal injury, they can be categorized into a few processes. The three primary processes reported in the literature are hemodynamic changes, inflammatory reactions, and nephrotoxicity. The majority of patients with AKI will suffer from more than one during their development and/or progression of AKI. Moreover, the development of one usually leads to the instigation of another. Thus, the interactions and progression between these mechanisms may determine the severity and duration of the AKI. Other factors such as organ crosstalk and how our concurrent therapies interact with these mechanisms complicate the pathophysiology of the progression of the AKI even further. In this narrative review article, we describe these three main pathophysiological processes that lead to the development and progression of AKI. © 2022 American Physiological Society. Compr Physiol 12: 3767–3780, 2022.

Figure 1. Figure 1. Three main pathophysiological mechanisms of the AKI with progressive impact of AKI risk if more than one of them is present.
Figure 2. Figure 2. AKI pathophysiology summary. Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved.
Figure 3. Figure 3. Major constituents responsible for AKI in the acute clinical setting.

Figure 1. Three main pathophysiological mechanisms of the AKI with progressive impact of AKI risk if more than one of them is present.

Figure 2. AKI pathophysiology summary. Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved.

Figure 3. Major constituents responsible for AKI in the acute clinical setting.
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Luis A. Juncos, Patrick M. Wieruszewski, Kianoush Kashani. Pathophysiology of Acute Kidney Injury in Critical Illness: A Narrative Review. Compr Physiol 2022, 12: 3767-3780. doi: 10.1002/cphy.c210028