Top

Published in:

01-12-2021 | Acute Kidney Injury | Commentary

Why the renin–angiotensin–aldosterone system (RAAS) in critically ill patients can no longer be ignored

Authors: Alexander Zarbock, Lakhmir Chawla, Rinaldo Bellomo

Published in: Critical Care | Issue 1/2021

Excerpt

Vasodilatory shock is a common form of shock, characterized by preserved or increased cardiac output and peripheral vasodilation. Inflammatory syndromes or states, such as sepsis and major surgery, are common causes of vasodilatory shock. Acute kidney injury (AKI) is a common complication of a vasodilatory shock and is associated with increased mortality [1]. Sepsis is the most common cause of AKI [2]. The pathophysiology of vasoplegia is complex and not fully understood, but different hormonal systems are involved in the regulation of systemic vascular resistance, including the renin–angiotensin–aldosterone system (RAAS). …

Joannidis M, Druml W, Forni LG, Groeneveld ABJ, Honore PM, Hoste E, Ostermann M, Oudemans-van Straaten HM, Schetz M. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017: expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine. Intensive Care Med. 2017;43(6):730–49.CrossRef

Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813–8.CrossRef

Chawla LS, Busse LW, Brasha-Mitchell E, Alotaibi Z. The use of angiotensin II in distributive shock. Crit Care. 2016;20(1):137.CrossRef

Flannery AH, Ortiz-Soriano V, Li X, Gianella FG, Toto RD, Moe OW, Devarajan P, Goldstein SL, Neyra JA. Serum renin and major adverse kidney events in critically ill patients: a multicenter prospective study. Crit Care. 2021;25(1):294.CrossRef

Bellomo R, Forni LG, Busse LW, McCurdy MT, Ham KR, Boldt DW, Hastbacka J, Khanna AK, Albertson TE, Tumlin J, et al. Renin and survival in patients given angiotensin ii for catecholamine-resistant vasodilatory shock: a clinical trial. Am J Respir Crit Care Med. 2020;202(9):1253–61.CrossRef

Rysz S, Al-Saadi J, Sjostrom A, Farm M, Campoccia Jalde F, Platten M, Eriksson H, Klein M, Vargas-Paris R, Nyren S, et al. COVID-19 pathophysiology may be driven by an imbalance in the renin-angiotensin-aldosterone system. Nat Commun. 2021;12(1):2417.CrossRef

Kullmar M, Saadat-Gilani K, Weiss R, Massoth C, Lagan A, Cortes MN, Gerss J, Chawla LS, Fliser D, Meersch M, et al. Kinetic changes of plasma renin concentrations predict acute kidney injury in cardiac surgery patients. Am J Respir Crit Care Med. 2021;203(9):1119–26.CrossRef

Jeyaraju M, McCurdy MT, Levine AR, Devarajan P, Mazzeffi MA, Mullins KE, Reif M, Yim DN, Parrino C, Lankford AS, et al. Renin kinetics are superior to lactate kinetics for predicting in-hospital mortality in hypotensive critically ill patients. Crit Care Med. 2021. https://doi.org/10.1097/CCM.0000000000005143.

Gleeson PJ, Crippa IA, Mongkolpun W, Cavicchi FZ, Van Meerhaeghe T, Brimioulle S, Taccone FS, Vincent JL, Creteur J. Renin as a marker of tissue-perfusion and prognosis in critically ill patients. Crit Care Med. 2019;47(2):152–8.CrossRef

10.

Shaw I, Rider S, Mullins J, Hughes J, Peault B. Pericytes in the renal vasculature: roles in health and disease. Nat Rev Nephrol. 2018;14(8):521–34.CrossRef

11.

Chen L, Kim SM, Eisner C, Oppermann M, Huang Y, Mizel D, Li L, Chen M, Sequeira Lopez ML, Weinstein LS, et al. Stimulation of renin secretion by angiotensin II blockade is Gsalpha-dependent. J Am Soc Nephrol. 2010;21(6):986–92.CrossRef

12.

Leisman DE, Fernandes TD, Bijol V, Abraham MN, Lehman JR, Taylor MD, Capone C, Yaipan O, Bellomo R, Deutschman CS. Impaired angiotensin II type 1 receptor signaling contributes to sepsis-induced acute kidney injury. Kidney Int. 2021;99(1):148–60.CrossRef

Title: Why the renin–angiotensin–aldosterone system (RAAS) in critically ill patients can no longer be ignored
Authors: Alexander Zarbock
Lakhmir Chawla
Rinaldo Bellomo
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Acute Kidney Injury
Shock
Shock
Acute Kidney Injury
Published in: Critical Care / Issue 1/2021
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-021-03816-x

2024 ASCO Annual Meeting

Springer Medicine

Why the renin–angiotensin–aldosterone system (RAAS) in critically ill patients can no longer be ignored

Excerpt

2024 ASCO Annual Meeting

Springer Medicine

Excerpt

Please log in to get access to this content

Other articles of this Issue 1/2021

A pilot study of trained ICU doulas providing early psychological support to critically ill patients

The immune modulatory effects of mitochondrial transplantation on cecal slurry model in rat

Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review

SARS-CoV-2 pneumonia—receptor binding and lung immunopathology: a narrative review

Comprehensive versus standard care in post-severe acute kidney injury survivors, a randomized controlled trial

Pneumocystis jirovecii pneumonia in COVID-19: an overlooked clinical entity—Response to “Pneumocystis pneumonia risk among viral acute respiratory distress syndrome related or not to COVID 19”