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Mauricio Del Rio J, Nicoara A, Swaminathan M. Neuroendocrine stress response: implications for cardiac surgery-associated acute kidney injury. Rom J Anaesth Intensive Care. 2017;24(1):57-63doi: 10.21454/rjaic.7518.241.hav.
Mauricio Del Rio, J., Nicoara, A., & Swaminathan, M. (2017). Neuroendocrine stress response: implications for cardiac surgery-associated acute kidney injury. Romanian journal of anaesthesia and intensive care, 24(1), 57-63. https://doi.org/10.21454/rjaic.7518.241.hav
Mauricio Del Rio, J, et al. "Neuroendocrine stress response: implications for cardiac surgery-associated acute kidney injury." Romanian journal of anaesthesia and intensive care vol. 24,1 (2017): 57-63. doi: https://doi.org/10.21454/rjaic.7518.241.hav
Mauricio Del Rio J, Nicoara A, Swaminathan M. Neuroendocrine stress response: implications for cardiac surgery-associated acute kidney injury. Rom J Anaesth Intensive Care. 2017 Apr;24(1):57-63. doi: 10.21454/rjaic.7518.241.hav. PMID: 28913500; PMCID: PMC5555430.
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Rom J Anaesth Intensive Care. 2017 Apr;24(1):57-63. doi: 10.21454/rjaic.7518.241.hav.

Neuroendocrine stress response: implications for cardiac surgery-associated acute kidney injury.

Romanian journal of anaesthesia and intensive care

J Mauricio Del Rio, Alina Nicoara, Madhav Swaminathan

Affiliations

  1. Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Health System, Durham, NC, USA.

PMID: 28913500 PMCID: PMC5555430 DOI: 10.21454/rjaic.7518.241.hav

Abstract

Surgical stress causes biochemical and physiologic perturbations of every homeostatic axis. These alterations include volume/baroreceptor regulation, sympathetic activation, parasympathetic suppression, neuroendocrine activation, acute phase response protein synthesis and secretion, immune response modulation and long-term behavioral adaptation. The kidney is central to the stress response because of its main role in the maintenance of water, electrolyte balance and hence, intracellular and extracellular compartments, including the intravascular volume. Acute kidney injury after cardiac surgery occurs as a result of numerous factors including ischemia-reperfusion, inflammation, oxidative stress, neurohormonal activation, metabolic factors, and nephrotoxicity or pigment nephropathy. The neuroendocrine stress response has a central role in initiating renal injury during cardiac surgery through an increased release of arginine-vasopressin and activation of the sympathetic nervous system and the intrarenal and systemic renin-angiotensin-aldosterone system. The contribution of an exaggerated neuroendocrine stress response to cardiac surgery and cardiopulmonary bypass as key pathophysiologic mechanism for acute kidney injury after cardiac surgery represents an opportunity for scientific exploration.

Keywords: acute kidney injury; cardiac surgery; neuroendocrine; surgical stress

Conflict of interest statement

Conflict of interest Nothing to declare

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