Pathways of renal injury in systemic gram-negative sepsis

ABSTRACT Acute renal failure is a grave complication of systemic gram‐negative sepsis. The pathophysiological mechanisms of sepsis leading to kidney injury result in part from systemic inflammatory and haemodynamic alterations. These are triggered by the interaction of endotoxin with Toll‐like recep...

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Bibliographic Details
Published in:European journal of clinical investigation 2008-10, Vol.38 (s2), p.39-44
Main Authors: El-Achkar, T. M., Hosein, M., Dagher, P. C.
Format: Article
Language:English
Subjects:
Acute kidney injury
Acute Kidney Injury - immunology
Acute Kidney Injury - metabolism
Acute Kidney Injury - pathology
acute renal failure
Animals
Endothelial Cells - metabolism
endotoxin
Endotoxins - metabolism
Gram-Negative Bacterial Infections - metabolism
Gram-Negative Bacterial Infections - microbiology
Gram-Negative Bacterial Infections - pathology
Humans
Kidney - immunology
Kidney - metabolism
Kidney - pathology
Sepsis - immunology
Sepsis - microbiology
Sepsis - pathology
TLR4
Toll-Like Receptor 4 - metabolism
toll-like receptors
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Summary:ABSTRACT Acute renal failure is a grave complication of systemic gram‐negative sepsis. The pathophysiological mechanisms of sepsis leading to kidney injury result in part from systemic inflammatory and haemodynamic alterations. These are triggered by the interaction of endotoxin with Toll‐like receptor 4 (TLR4) on cells of the immune system. Recently, TLR4 and other co‐effector molecules were identified on renal tubular and vascular cells. Furthermore, it was demonstrated that systemic endotoxin has direct access to renal sites where these receptors are expressed. Therefore, we review data in support of this novel pathway of renal injury in sepsis, whereby systemic endotoxin causes direct injury through interactions with local epithelial and endothelial TLR4.
ISSN:0014-2972
1365-2362
DOI:10.1111/j.1365-2362.2008.02007.x