Figure 1 Pulmonary oedema in AKI

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ALOK SINHA Department of Medicine Manipal College of Medical Sciences Pokhara, Nepal.

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Figure 1 Pulmonary oedema in AKI Figure 1 | Pulmonary oedema in AKI. a | Spectrum of pulmonary oedema in AKI. Cardiogenic pulmonary oedema is caused by fluid overload and/or cardiac dysfunction, leading to increased capillary hydrostatic pulmonary pressure and transudative pulmonary oedema. Patients can improve quickly with fluid removal via ultrafiltration or diuresis. Non-cardiogenic pulmonary oedema is caused by injury to the capillary membrane, leading to increased leak and proteinacious pulmonary oedema. Patients improve little or not at all with fluid removal via ultrafiltration or diuresis. Many patients likely fall in the spectrum between cardiogenic and non-cardiogenic pulmonary oedema. b | Cardiogenic pulmonary oedema is characterized by bilateral infiltrates visible after chest radiography, and is generally without histologic or biochemical evidence of inflammation. Accurate measurements of central venous pressure or pulmonary artery occlusion pressure (PAOP; previously known as pulmonary capillary wedge pressure) are increased. c | Histologic image showing interstitial oedema (arrows). d | Non-cardiogenic pulmonary oedema is characterized by bilateral infiltrates visible after chest radiography, as well as histologic or biochemical evidence of inflammation. Accurate measurements of central venous pressure of PAOP are usually normal or low. e | Normal lung histology. f | The histologic image shows proteineaceous oedema (thick arrow) and interstitial oedema (thin arrows). g | The magnified histologic image shows neutrophils in interstitial space (thick arrow) and interstitial oedema (thin arrow) typical of non-cardiogenic pulmonary oedema. Faubel, S. & Edelstein, C. L. (2015) Mechanisms and mediators of lung injury after acute kidney injury Nat. Rev. Nephrol. doi:10.1038/nrneph.2015.158