Background: Pulmonary complications often occur in patients with acute kidney injury, and represent an important cause of death.
Objective: To analyze the complexity of lung disorders in patients with RIFLE class III acute kidney injury undergoing hemodialysis and the physiopathological mechanisms that cause the various pulmonary complications.
Methods: Our study included 74 clinical cases of acute kidney injury of various etiologies (severe sepsis, trauma, post-surgery, toxic, etc.). The respiratory function of these patients was monitored from the clinical and radiological points of view. Deceased patients underwent autopsy.
Results: Pulmonary complications occurred in 47.24% of cases. Most pulmonary complications (over 50%) occurred in sepsis-induced acute kidney injury.Regarding the clinical aspects of pulmonary complications, the most frequent were ARDS, atelectasisand bronchopneumopathies, determined by the etiological factors that had caused the acute kidney injury in the first place, and by the acute kidney injury-induced physiological effects.
Conclusions: 1. The frequency of pulmonary complications in acute kidney injury is very high and has a negative impact on the evolution and prognosis. 2. The etiology of the pulmonary complications is complex, as these are caused by the agents that induced the acute kidney injury in the first place, most frequently by septic shock. 3. Along with clinical and radiological evidence of pulmonary damage, severe pulmonary histological lesions were found in deceased patients, with a high contribution to the increased mortality rate.
Keywords: Acute kidney injury; acute respiratory distress syndrome; hemodialysis; pulmonary complications; sepsis.