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Review
. 2023 Feb 9;12(4):1373.
doi: 10.3390/jcm12041373.

Norepinephrine May Exacerbate Septic Acute Kidney Injury: A Narrative Review

Lou'i Al-Husinat  1 , Alameen Alsabbah  2 , Amer Abu Hmaid  2 , Razan Athamneh  2 , Majd Adwan  2 , Mohammad N Hourani  2 , Seif Almakhadmeh  2 , Zaid Jehad Al Modanat  1 , Mohammed I A Ismail  3 , Giustino Varrassi  4
Affiliations
Review

Norepinephrine May Exacerbate Septic Acute Kidney Injury: A Narrative Review

Lou'i Al-Husinat et al. J Clin Med. .

Abstract

Sepsis, the most serious complication of infection, occurs when a cascade of potentially life-threatening inflammatory responses is triggered. Potentially life-threatening septic shock is a complication of sepsis that occurs when hemodynamic instability occurs. Septic shock may cause organ failure, most commonly involving the kidneys. The pathophysiology and hemodynamic mechanisms of acute kidney injury in the case of sepsis or septic shock remain to be elucidated, but previous studies have suggested multiple possible mechanisms or the interplay of multiple mechanisms. Norepinephrine is used as the first-line vasopressor in the management of septic shock. Studies have reported different hemodynamic effects of norepinephrine on renal circulation, with some suggesting that it could possibly exacerbate acute kidney injury caused by septic shock. This narrative review briefly covers the updates on sepsis and septic shock regarding definitions, statistics, diagnosis, and management, with an explanation of the putative pathophysiological mechanisms and hemodynamic changes, as well as updated evidence. Sepsis-associated acute kidney injury remains a major burden on the healthcare system. This review aims to improve the real-world clinical understanding of the possible adverse outcomes of norepinephrine use in sepsis-associated acute kidney injury.

Keywords: norepinephrine; sepsis; septic acute kidney injury; septic shock; vasopressin; vasopressor.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The outcomes of S-AKI. Note that the glomerular filtration rate is reduced only due to the influx of sodium produced by downregulation of the sodium/potassium pump; it is not an initiator. Abbreviations: GFR, glomerular filtration rate; S-AKI, septic acute kidney injury.
Figure 2
Figure 2
The role of pro-inflammatory mediators in S-AKI. Abbreviations: GFR, glomerular filtration rate; S-AKI, septic acute kidney injury; WBC, white blood cells.
Figure 3
Figure 3
How S-AKI can lead to cell membrane damage and necrosis. Abbreviations: DAMPs, damaged-associated molecular patterns; NGAL, neutrophil gelatinase-associated lipocalin; PAMPs, pathogen-associated molecular patterns; ROS, reactive oxygen species; TLR, Toll-like receptor.
See this image and copyright information in PMC

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