Q&A-Lungs and Kidneys in Collision: The ARDS–AKI Crossroads

Lungs and Kidneys in Collision: The ARDS–AKI Crossroads

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1. In a ventilated ARDS patient who develops AKI with rising CVP and falling urine output, which physiological parameter most directly indicates that PEEP has begun to compromise renal perfusion?

A. Worsening oxygenation index despite stable lung compliance

B. Rising central venous pressure with dampened renal venous Doppler waveform

C. Decreased PaCO₂ due to improved alveolar recruitment

D. Increased mixed venous oxygen saturation following higher PEEP

2.Regarding permissive hypercapnia in ARDS management, which of the following mechanisms best explains potential renal harm observed in experimental models?

A. Direct nephrotoxicity of carbon dioxide on tubular cells

B. Sympathetic activation causing renal vasoconstriction and transient hypoperfusion

C. Metabolic alkalosis secondary to bicarbonate buffering

D. Decreased renin–angiotensin activity due to vasodilatation

3. Cytokine spillover in ARDS has been implicated in kidney injury through which predominant pathophysiologic process?

A. Reduced cardiac output and renal ischemia

B. Tubular obstruction from cellular debris

C. Endothelial dysfunction and microvascular inflammation independent of blood pressure

D. Activation of the renin–angiotensin system secondary to hypoxia

4. In a patient with moderate ARDS and concomitant CRRT, progressive metabolic acidosis during ventilator weaning most likely reflects:

A. Excess citrate buffering by CRRT

B. Reduced renal bicarbonate regeneration and CO₂ clearance mismatch

C. Hyperventilation-induced hypocapnia

D. Improved tissue perfusion with rising lactate clearance

5. When tailoring enteral nutrition for a ventilated ARDS–AKI patient, which modification most appropriately reduces CO₂ generation while maintaining nitrogen balance?

A. Increasing carbohydrate calories to improve metabolic efficiency

B. Using protein-restricted, high-glucose formula

C. Substituting a portion of carbohydrate calories with lipid-based energy sources

D. Employing hypocaloric feeding with low fat and high carbohydrate ratios

6. Which of the following statements about using VeXUS (Venous Excess Ultrasound Score) to guide fluid removal in ARDS–AKI overlap is most accurate given current evidence?

A. VeXUS has strong RCT-level evidence supporting reduced mortality when used to guide ultrafiltration.

B. VeXUS primarily detects left atrial pressure changes and has poor correlation with venous congestion.

C. VeXUS can identify venous congestion patterns that precede worsening renal function, but data remain limited to small observational studies.

D. VeXUS measurement requires invasive catheterization for calibration of portal venous pressure.

7. During CRRT in severe ARDS, what physiologic mechanism explains worsening oxygenation when ultrafiltration rates are excessively high?

A. Reduction in alveolar dead space

B. Hypovolemia-induced derecruitment and impaired pulmonary perfusion

C. Increased pulmonary compliance due to fluid removal

D. Hypercapnia-mediated vasodilatation improving V/Q mismatch

8. The emerging concept of ARDS–AKI subphenotyping seeks to improve outcomes primarily by:

A. Stratifying patients by creatinine trajectory and urine output trends

B. Tailoring ventilation and renal replacement parameters to distinct inflammatory and hemodynamic profiles

C. Excluding patients with sepsis from ARDS studies to reduce heterogeneity

D. Standardizing PEEP and CRRT prescriptions across all ICU patients

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Comment (2)
Gerd says:

November 16, 2025 at 4:56 pm

Ok

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KEDAR TORASKAR says:

November 16, 2025 at 4:08 pm

Interesting crossover concept

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Lungs and Kidneys in Collision: The ARDS–AKI Crossroads

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