Haemodynamic influences on kidney oxygenation: Clinical implications of integrative physiology

Roger G. Evans, Can Ince, Jaap A. Joles, David W. Smith, Clive N. May, Paul M O'Connor, Bruce S. Gardiner

Research output: Contribution to journalReview article

120 Citations (Scopus)

Abstract

Renal blood flow, local tissue perfusion and blood oxygen content are the major determinants of oxygen delivery to kidney tissue. Arterial pressure and segmental vascular resistance influence kidney oxygen consumption through effects on glomerular filtration rate and sodium reabsorption. Diffusive shunting of oxygen from arteries to veins in the cortex and from descending to ascending vasa recta in the medulla limits oxygen delivery to renal tissue. Oxygen shunting depends on the vascular network, renal haemodynamics and kidney oxygen consumption. Consequently, the impact of changes in renal haemodynamics on tissue oxygenation cannot necessarily be predicted intuitively and, instead, requires the integrative approach offered by computational modelling and multiple measuring modalities. Tissue hypoxia is a hallmark of acute kidney injury (AKI) arising from multiple initiating insults, including ischaemia-reperfusion injury, radiocontrast administration, cardiopulmonary bypass surgery, shock and sepsis. Its pathophysiology is defined by inflammation and/or ischaemia resulting in alterations in renal tissue oxygenation, nitric oxide bioavailability and oxygen radical homeostasis. This sequence of events appears to cause renal microcirculatory dysfunction, which may then be exacerbated by the inappropriate use of therapies common in peri-operative medicine, such as fluid resuscitation. The development of new ways to prevent and treat AKI requires an integrative approach that considers not just the molecular mechanisms underlying failure of filtration and tissue damage, but also the contribution of haemodynamic factors that determine kidney oxygenation. The development of bedside monitors allowing continuous surveillance of renal haemodynamics, oxygenation and function should facilitate better prevention, detection and treatment of AKI.

Original languageEnglish (US)
Pages (from-to)106-122
Number of pages17
JournalClinical and Experimental Pharmacology and Physiology
Volume40
Issue number2
DOIs
StatePublished - Feb 1 2013

Fingerprint

Hemodynamics
Kidney
Oxygen
Acute Kidney Injury
Oxygen Consumption
Renal Circulation
Reperfusion Injury
Cardiopulmonary Bypass
Glomerular Filtration Rate
Rectum
Resuscitation
Vascular Resistance
Biological Availability
Blood Vessels
Veins
Shock
Reactive Oxygen Species
Sepsis
Arterial Pressure
Nitric Oxide

Keywords

  • Acute kidney injury
  • Kidney circulation
  • Mathematical model
  • Oxygen consumption
  • Oxygen delivery
  • Tissue oxygenation

ASJC Scopus subject areas

  • Physiology
  • Pharmacology
  • Physiology (medical)

Cite this

Haemodynamic influences on kidney oxygenation : Clinical implications of integrative physiology. / Evans, Roger G.; Ince, Can; Joles, Jaap A.; Smith, David W.; May, Clive N.; O'Connor, Paul M; Gardiner, Bruce S.

In: Clinical and Experimental Pharmacology and Physiology, Vol. 40, No. 2, 01.02.2013, p. 106-122.

Research output: Contribution to journalReview article

Evans, Roger G. ; Ince, Can ; Joles, Jaap A. ; Smith, David W. ; May, Clive N. ; O'Connor, Paul M ; Gardiner, Bruce S. / Haemodynamic influences on kidney oxygenation : Clinical implications of integrative physiology. In: Clinical and Experimental Pharmacology and Physiology. 2013 ; Vol. 40, No. 2. pp. 106-122.
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