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Pathophysiologic Mechanisms of Acute Renal Failure
Published in Robin S. Goldstein, Mechanisms of Injury in Renal Disease and Toxicity, 2020
Although renal vasoconstriction does not appear to be the primary abnormality in most types of acute renal failure and, therefore, the term vasomotor nephropathy is not a good one, abnormalities in the vasculature of kidneys with acute renal failure can still contribute to renal functional abnormalities. Matthys and colleagues26 noted extensive changes in the arteries and arterioles of rat kidneys subjected to 40 min of ischemia. Arcuate and interlobular arteries, as well as afferent arterioles, showed focal, segmental necrosis of smooth muscle cells 7 d after ischemia. These blood vessels also showed thickening and fibrosis of the adventitial layers of the arteries. These abnormalities are the histologic counterparts of an impairment in autoregulation of renal blood flow which persists for days to weeks after renal ischemia.
Optimizing Physiology and Body Composition; Determining the Optimal Weight Category
Published in Charles Paul Lambert, Physiology and Nutrition for Amateur Wrestling, 2020
What kind of problems does severe dehydration cause? Dehydration can cause problems with mood and cognition (the ability to think), delirium, and headache (Popkin, D’Aaci, and Rosenberg 2010). Additionally, dehydration can result in a reduction in blood volume which will increase heart rate, and if the reduction in blood volume is great enough there will be a reduction in blood pressure (Popkin, D’Aaci, and Rosenberg 2010). Along with this reduction in blood pressure is a reduced blood flow to the kidneys that if severe enough can cause renal ischemia (Popkin, D’Aaci, and Rosenberg 2010). This is simply a reduction in blood flow to the kidneys. No blood flow and no oxygen delivery, no oxygen delivery and tissues can only work for a very short time without oxygen. Eventually, portions of the tissue, in this case the kidney, could die as a result of the lack of oxygen resulting in an infarction. We all know what a myocardial infarction is, a heart attack. Thus, tissue dying off such as kidney tissue will impair the function of that organ. Clearly, not a situation a teenager or young adult wants.
The kidneys
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Atheroma is not uncommon in the main renal arteries of patients with generalized atherosclerosis. This often occurs due to encroachment of aortic atheromatous plaque(s) into the ostium of the renal artery, and may also be present more distally. Renal ischaemia due to atherosclerotic stenosis of the renal arteries is an important cause of renal failure in elderly people and may also cause hypertension and cardiac failure. In some cases these features can be improved by relief of the stenosis by surgery, or more often by radiologically guided angioplasty.
Difficulty and importance of diagnosing stenosis of renal branch artery in fibromuscular dysplasia: a case report
Published in Blood Pressure, 2021
Andreas Skræddergaard, Jakob Nyvad, Kent Lodberg Christensen, Arne Hørlyck, Hossein Mohit Mafi, Mark Reinhard
In our case, PTRA was offered with the aim of limiting both the need for life-long antihypertensive therapy and the potential complications to hypertension. Besides normalisation of the BP, PTRA also seemed to improve the right sided abdominal pain, which in this case was the original cause of referral to the hospital. As much as 14.6% of patients with FMD present with flank or abdominal pain, according to the US registry for FMD [10]. In the paediatric population, abdominal/flank pain was less common as a presenting symptom at 7.1%. In this patient group, both headache and dizziness were found to be more common presenting symptoms [10]. Abdominal pain is well described when it derives from other vascular beds, such as the mesenteric arteries. It is also known that FMD often involves more than just the renal arteries [6]. However, in this case the right sided abdominal pain only sporadically returned after PTRA which may indicate that the pain was related to the right sided renal branch artery stenosis. Acute abdominal pain can be a symptom of acute renal ischaemia resulting from occlusion of one or both renal arteries [6].
Outcomes and risk management in type B aortic dissection patients with acute kidney injury: a concise review
Published in Renal Failure, 2021
Xiaolan Chen, Ming Bai, Shiren Sun, Xiangmei Chen
There are also promising tools on the horizon, which can help in either the prevention or early detection of AKI. Radiologic signs might allow for early detection of visceral malperfusion prior to clinical presentations. Regarding the pathophysiological mechanism of renal malperfusion, the reduction of renal blood flow caused by branch obstruction plays an important role in patients with type B aortic dissection. CTA-based intima dynamic motion measurements can be useful in early AKI detection. Zhao et al. [18] proved that intima dynamic motion may help early detection of renal ischemia by initial CTA examination prior to the presence of clinical indicators. Additionally, a large fluctuation of the intima could increase the incidence of adverse events, especially AKI, postoperatively. The effect of intima dynamic motion on AKI for type B aortic dissection patients remains to be further studied.
Renal tubular cell death and inflammation response are regulated by the MAPK-ERK-CREB signaling pathway under hypoxia-reoxygenation injury
Published in Journal of Receptors and Signal Transduction, 2019
Qi Dong, Yingxin Jie, Jian Ma, Chen Li, Ting Xin, Dingwei Yang
Renal I/R injury represents a major complication during renal ischemia Timely reperfusion following acute ischemia is crucial as it shows diverse benefits by rescuing the remaining viable renal tissue, restricting the increase in tubular death, conserving kidney function, and preventing the occurrence of renal fibrosis [72,73]. However, it can independently lead to tubular cell death, defined as lethal renal reperfusion injury [74]. However, no therapeutic approaches are effective to reduce the renal ischemia-reperfusion injury [75]. In the present study, we used a hypoxia-reoxygenation model to observe the molecular alterations of acute kidney injury [76,77]. Our results demonstrated that hypoxia-reoxygenation injury significantly reduced cell viability and increased HK2 cell apoptosis in a time-dependent manner [78,79]. Mechanically, hypoxia-reoxygenation injury deactivated the activity of MAPK-ERK-CREB signaling pathway and this effect contributed to HK2 cell death and inflammation response [80]. Interestingly, re-activation of MAPK-ERK-CREB pathway could reverse cell viability [81] and thus reduce inflammation response [82] in HK2 cells under hypoxia-reoxygenation injury [83]. Altogether, our results report a novel signaling pathway responsible for HK2 cell death under hypoxia-reoxygenation injury [84].