What are the non hemodynamic factors that occur in sepsis that can lead to AKI?
a. Inflammatory mediators (cytokines [such as interleukin-6 and -10], vasoactive substances, arachidonic acid metabolites) are released during sepsis and may have a significant pathogenic role.
b. Apoptosis (programmed cell death) occurs in response to immune-mediated cell injury. In contrast, tubular necrosis caused by ischemia also happens in sepsis. There is now good evidence to show that human kidney tubular cells die by apoptosis and necrosis in experimental models of acute ischemic and toxic kidney injury.
c. Endothelial cell dysfunction may also lead to ischemia.
d. Activation of coagulation pathways may impair renal microcirculatory blood flow.
e. Reactive oxygen species, proteases, elastases, myeloperoxidase, and other enzymes are released from activated immune cells and damage tubular cells.
