Renal Failure

Acute kidney injury is a serious morbid event among critically ill and postoperative patients, with profound implications for both short and long-term adverse outcomes. One of the most frequent causes of acute kidney injury in these settings is compromised net renal perfusion pressure. While mean arterial pressure, as the main contributor to renal perfusion, has a vast amount of scientific literature supporting its significance, equally important are the other relevant forces shaping net renal perfusion. Increased intraabdominal pressure inhibits glomerular filtration by elevating proximal tubular pressure and raising renal venous pressure, which hampers blood emptying from glomeruli. Hindered outflow of blood alone has been recognized in the last decade as a contributing factor of acute kidney injury due to venous congestion.

The consequence of the imbalance between renal inflow and outflow is increased interstitial pressure instead of swelling due to the tense capsule of the kidneys. Lymphatic drainage serves as a rescue valve but has limited capacity. Worsening kidney function extends dysfunction to other vital organs via hepato-renal and cardio-renal crosstalk, resulting in general edema formation. The vicious circle is often initiated or induced by intravenous fluid administered for restoration of circulating blood volume and maintaining adequate mean arterial pressure.

This special announcement aims to provide a collection of articles relevant to renal perfusion pressure and all related investigations examining contributors to acute kidney injury in peri-operative and Intensive Care Unit environments. We are interested in manuscripts presenting new hypotheses, novel observations, analysis of the role of perfusion pressure and renal blood flow in acute kidney injury, and proposals for novel monitoring methods and therapeutic interventions.

Subtopics included are: net renal perfusion pressure and

1.) acute kidney injury in critically ill patients;

2.) acute kidney injury in postoperative patients;

3.) acute kidney injury in cardio-renal and hepato-renal pathologies;

4.) clinical implications of intrarenal hemodynamic disturbances (e. g. in sepsis).

Keywords: acute kidney injury, intrabdominal pressure, intrarenal hemodynamics, organ crosstalk, renal congestion, renal perfusion pressure, renal venous pressure

Csaba Kopitkó, MD., Ph. D. is an attending physician in the Uzsoki Street Hospital, a Teaching Hospital of Semmelweis University, Budapest, Hungary (https://www.uzsoki.hu/orvoskereso?title=kopitk%C3%B3&field_doctor_position_target_id=&title_department=) . Dr. Kopitkó's original research has served as the cornerstone of his Ph.D. thesis, delving into the realm of perioperative acute kidney injury and renal perfusion. You can explore the link to his Ph.D. thesis here: https://repo.lib.semmelweis.hu/handle/123456789/8709. Notably, he earned his PhD degree in 2020 with the "summa cum laude" from Semmelweis University in Budapest. Continuing his pursuit of excellence, Dr. Kopitkó and his co-authors have since contributed three influential review papers on the hemodynamics of the kidney, highlighting factors like venous congestion and renal lymphatic drainage.

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