Renal blood flow in sepsis a complex issue 英文参考文献.docVIP

Available online /content/9/4/327 Commentary Renal blood flow in sepsis: a complex issue Bruce A Molitoris Division of Nephrology, Department of Medicine and the Indiana Center for Biological Microscopy, Indiana University School of Medicine, Indianapolis, IN, USA, and The Roudebush VA Medical Center, Indianapolis, IN, USA Corresponding author: Bruce A Molitoris, bmolitor@ Published online: 2 June 2005 Critical Care 2005, 9:327-328 (DOI 10.1186/cc3740) This article is online at /content/9/4/327 ? 2005 BioMed Central Ltd See related research article by Langenberg et al. in this issue [/content/9/4/R363] Abstract studies have used the administration of LPS in high dose to initiate a ‘sepsis-like syndrome’ [5]. The clinical complexity of sepsis and the regional variability in renal blood flow present a difficult challenge for the clinician or investigator in understanding the role and clinical importance of reduced blood flow in the pathophysiology of sepsis-induced acute renal failure. Understanding the role of regional microvasculature flow and interactions between endothelium and white blood cells in the local delivery of oxygen and substrates is of critical importance. Therefore, measuring total renal blood flow may not Although the LPS model can have a role in helping to understand the sepsis phenotype, many investigators now favor the use of the CLP model for several reasons. First, sepsis is a complex phenomenon and although it is in part due to the generation, release and biologic reactions of LPS, additional factors are present in clinical sepsis that are more completely modeled by bacterial-generated models such as CLP [6]. Second, although both LPS and CLP models had similar mortality rates, there were significant differences in the kinetics and magnitude of cytokine production. The very rapid production and extremely high levels of