Nephrogenic acute respiratory distress syndrome: A narrative review on pathophysiology and treatment / 中华创伤杂志(英文版)

The kidneys have a close functional relationship with other organs especially the lungs. This connection makes the kidney and the lungs as the most organs involved in the multi-organ failure syndrome. The combination of acute lung injury (ALI) and renal failure results a great clinical significance of 80% mortality rate. Acute kidney injury (AKI) leads to an increase in circulating cytokines, chemokines, activated innate immune cells and diffuse of these agents to other organs such as the lungs. These factors initiate pathological cascade that ultimately leads to ALI and acute respiratory distress syndrome (ARDS). We comprehensively searched the English medical literature focusing on AKI, ALI, organs cross talk, renal failure, multi organ failure and ARDS using the databases of PubMed, Embase, Scopus and directory of open access journals. In this narrative review, we summarized the pathophysiology and treatment of respiratory distress syndrome following AKI. This review promotes knowledge of the link between kidney and lung with mechanisms, diagnostic biomarkers, and treatment involved ARDS induced by AKI.

Brain consequences of acute kidney injury: Focusing on the hippocampus

The high mortality rates associated with acute kidney injury are mainly due to extra-renal complications that occur following distant-organ involvement. Damage to these organs, which is commonly referred to as multiple organ dysfunction syndrome, has more severe and persistent effects. The brain and its sub-structures, such as the hippocampus, are vulnerable organs that can be adversely affected. Acute kidney injury may be associated with numerous brain and hippocampal complications, as it may alter the permeability of the blood-brain barrier. Although the pathogenesis of acute uremic encephalopathy is poorly understood, some of the underlying mechanisms that may contribute to hippocampal involvement include the release of multiple inflammatory mediators that coincide with hippocampus inflammation and cytotoxicity, neurotransmitter derangement, transcriptional dysregulation, and changes in the expression of apoptotic genes. Impairment of brain function, especially of a structure that has vital activity in learning and memory and is very sensitive to renal ischemic injury, can ultimately lead to cognitive and functional complications in patients with acute kidney injury. The objective of this review was to assess these complications in the brain following acute kidney injury, with a focus on the hippocampus as a critical region for learning and memory.

[Occupational stress and influencing factors, in medical residents of one of the educational hospitals of Tehran University of Medical Sciences]

Occupational stress is one of the most common hazards in workplaces and leads to different physical, mental, and behavioral outcomes and complications. Medical residents, due to the nature and characteristics of their job, confront various stressors. This study has been designed in order to identify the frequency of occupational stress in medical residents and factors influencing it. This cross-sectional study was conducted on 305 residents with various specialties in Rasoul-e-Akram Hospital on spring 1389. For measuring the degree of stress, we used Osipow occupational stress inventory. T-test, Chi-Square, ANOVA and Logistic regression were used to evaluate associations. Response rate was 87%. Most of the residents had moderate stress. Average score of total stress was 147.06 from 250. The most frequent stressor was work overload [31.05 from 50] and responsibility [29.55 from 50]. Stress significantly increased with shift work [OR=4.591, CI=1.31-16.13, p=0.017], surgery [OR=3.769, CI=2.10-6.76, p=0.001] and also correlated with lower rest time [OR=1.962, CI=1.12-4.08, p=0.048] and higher weekly work hours [OR=1.242, CI=1.10-2.34, p=0.050]. The most frequent stressors were work overload and responsibility, so it is recommended that in order to reduce stress, work hours must be limited and the residents must be strongly supported. In addition, some education and consultation for specialty choice must be given to the physicians