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Die akute Nierenschädigung

Acute kidney injury

  • Übersicht
  • Published:
Intensivmedizin und Notfallmedizin

Zusammenfassung

Die akute Nierenschädigung ist in der Intensivmedizin diejenige Organdysfunktion, die den wohl entscheidendsten Einfluss auf Krankheitsverlauf und Langzeitprognose des kritisch kranken Patienten hat. Die exzessive „Übersterblichkeit“ von Intensivpatienten mit nierenersatzpflichtigem Nierenversagen kann weder durch frühzeitigeren Einsatz der Detoxifikationstechniken, noch durch höhere Eliminationsraten klein- und mittelmolekularer urämischer Toxine (höhere Dosis oder Frequenz der Nierenersatztherapie) oder eine spezifischere Auswahl der verfügbaren Verfahren reduziert werden. Die Auswirkungen der akuten Nierenschädigung per se auf andere Organsysteme erklären sich somit weniger durch urämische Sekundäreffekte, sondern scheinen auf systemischer akuter Inflammation zu beruhen.

Die 5-Jahresüberlebensrate ehemaliger Intensivpatienten mit nierenersatzpflichtigem akutem Nierenversagen liegt bei 20–30% und entspricht damit der von malignen Erkrankungen. Die akute Nierenschädigung ist zudem ein Risikofaktor für die progrediente chronische Nierenerkrankung bis hin zum dialysepflichtigen Nierenversagen. Gegenstand der aktuellen Forschung muss eine verbesserte Prävention durch Identifikation von Risikofaktoren und die frühzeitige Diagnose und Therapie der subklinischen renalen Schäden sein.

Abstract

Acute kidney injury plays a pivotal role in intensive care medicine and exerts crucial adverse effects on the course of the disease and overall prognosis of the critically ill patient. Intensive renal support, including initiation of earlier dialysis or maximal uremic toxin removal by higher dosage and frequency of renal replacement therapy, and individualized selection of modality were not able to decrease excessive mortality in this population. Systemic acute inflammation, mediated, at least in part, by cytokines, and not secondary uremic side effects, seems to have a major impact on nonrenal organ damage.

Assessment of short-term outcome in critically ill patients who develop acute kidney injury may underestimate the true burden of disease. The overall survival at 5 years in patients discharged alive after severe acute kidney injury necessitating renal replacement therapy is only 20–30%, comparable to cancer patients. In addition, acute renal damage was identified as an independent risk factor for progression of chronic renal insufficiency. Current research focuses on strategies for the prevention of acute kidney injury and on the establishment of effective biomarkers for the early recognition and accurate diagnosis of subclinical renal damage.

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  1. KfH Kuratorium für Dialyse und Nierentransplantation e.V., KFH Nierenzentrum, Elsenheimerstr. 63, 80687, München, Deutschland

    H. Schmid,  H. Schiffl & S.R. Lederer

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  1. H. Schmid
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  2. H. Schiffl
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  3. S.R. Lederer
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Correspondence to H. Schiffl.

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Schmid, H., Schiffl, H. & Lederer, S. Die akute Nierenschädigung. Intensivmed 48, 468–473 (2011). https://doi.org/10.1007/s00390-011-0270-1

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  • DOI: https://doi.org/10.1007/s00390-011-0270-1

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