Metabolism and Homeostasis

Coordinators: Antonio Fioccola, Simone Gatarello

Objective

The research group on kidney and metabolism aims to investigate both invasive and non-invasive tools in patients admitted to Intensive Care Units, with the goal of elucidating the complex mechanisms that influence renal function and metabolism. The value of such information primarily lies in understanding the multi-organ interactions that occur in critically ill patients, with particular focus on cardiorenal and pneumorenal syndromes. The ultimate goal is to enable early diagnosis and initiate timely treatments to prevent and manage renal and metabolic damage observed during the treatment of critically ill patients.

Methodology

All proposals that align with the scientific principles of Good Clinical Practice (GCP) and aim to gather data on multi-organ interactions—especially renal and metabolic functions in critically ill patients—will be considered.

Physiology

Cardiorenal and pneumorenal syndromes are well-established entities in the medical literature [1–3]. Diagnosis of these conditions currently relies primarily on laboratory tests such as serum creatinine, blood urea nitrogen, and 24-hour creatinine clearance. These assessments guide therapeutic strategies designed to reduce their incidence and severity. The use of alternative, rapid diagnostic methodologies could thus be critical in improving patient outcomes.

Translational Approach

Physiological evidence supports the use of urinary electrolytes [4], and pre-clinical research into their application has paved the way for their integration into clinical research. This is facilitated by their minimally invasive nature and the availability of tools capable of real-time measurement of relevant analytes. Among these tools is the K.IN.G. (Kidney Instant monitorinG), which is already supported by scientific evidence [5,6], and is currently utilized in pre-clinical research under conditions that simulate those of intensive care patients (mechanical ventilation, sepsis, administration of vasoactive agents). The implementation of such a tool in clinical practice would allow for an extensive investigation of urinary electrolytes in response to para-physiological and pathological stimuli, enabling deeper understanding of renal compensatory mechanisms in the context of metabolic disturbances, hemodynamic alterations, and mechanical ventilation.

Bibliography

1. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol. 2008 Nov 4;52(19):1527-39. doi: 10.1016/j.jacc.2008.07.051. PMID: 19007588.
   
   
2. Ronco C, Bellasi A, Di Lullo L. Cardiorenal Syndrome: An Overview. Adv Chronic Kidney Dis. 2018 Sep;25(5):382-390. doi: 10.1053/j.ackd.2018.08.004. PMID: 30309455.
   
   
3. Boyle N, O'Callaghan M, Ataya A, Gupta N, Keane MP, Murphy DJ, McCarthy C. Pulmonary renal syndrome: a clinical review. Breathe (Sheff). 2022 Dec;18(4):220208. doi: 10.1183/20734735.0208-2022. Epub 2023 Jan 10. PMID: 36865943; PMCID: PMC9973488.
   
   
4. Svendsen SL, Rousing AQ, Carlsen RK, Khatir D, Jensen D, Hansen NM, Salomo L, Birn H, Buus NH, Leipziger J, Sorensen MV, Berg P. A Urine pH-Ammonium Acid/Base Score and CKD Progression. J Am Soc Nephrol. 2024 Nov 1;35(11):1533-1545. doi: 10.1681/ASN.0000000000000447. Epub 2024 Jul 17. PMID: 39485702; PMCID: PMC11543018.
   
   
5. Caironi P, Langer T, Taccone P, Bruzzone P, De Chiara S, Vagginelli F, Caspani L, Marenghi C, Gattinoni L. Kidney instant monitoring (K.IN.G): a new analyzer to monitor kidney function. Minerva Anestesiol. 2010 May;76(5):316-24. Epub 2010 Mar 24. PMID: 20395893.
   
   
6. Febres D, Langer T, Cressoni M, Protti A, Coppola S, Mietto C, Santini A, Lombardi L, Lazzerini M, Cadringher P, Bertoli P, Gattinoni L. Continuous urinary electrolyte measurement in a swine model of mechanical ventilation. Crit Care. 2010;14(Suppl 1):P523. doi: 10.1186/cc8755. Epub 2010 Mar 1. PMCID: PMC2934088.