Akutes Nierenversagen – Prävention, Risikostratifizierung und Biomarker

Zusammenfassung

Das Auftreten eines akuten Nierenversagens beeinflusst Morbidität und Mortalität des Intensivpatienten negativ und verursacht erhebliche Kosten durch eine verlängerte Verweildauer auf der Intensivstation. Die Diagnose und Klassifikation des akuten Nierenversagens erfolgt derzeit anhand der RIFLE- und AKIN-Kriterien mittels Serumkreatinin und Urinausscheidung. Die möglichen prä-, intra- und postrenalen Ursachen eines akuten Nierenversagens sind Ansatzpunkte einer präventiven Therapie und Risikostratifizierung.Da gerade das Serumkreatinin beim Intensivpatienten einen unzuverlässigen Parameter darstellt, ruht die Hoffnung auf neuen Biomarkern. Bislang hat jedoch keiner der aussichtsreichen Kandidaten den Weg in die klinische Routine gefunden. Zur Beurteilbarkeit des klinischen Nutzens müssen die Ergebnisse großer prospektiver Multizenter-Studien abgewartet werden.

Abstract

Acute kidney injury influences negatively morbidity and mortality of the critically ill patient and causes increased costs by prolonged length of stay in the intensive care unit.At present the diagnosis and classification of acute kidney injury is derived from the RIFLE and AKIN criteria based on serum creatinine and urine output. The possible pre-, intra- and postrenal causes of acute kidney injury are the starting points of preventive therapy and risk stratification.Because of the unreliability of serum creatinine in critically ill patients the development of new biomarkers raises hope. But none of the promising candidates is used in clinical routine up to now. For evaluation of clinical benefit the results of large prospective multicenter studies have to be awaited.

Schlüsselwörter:

akutes Nierenversagen - Prävention - Risikostratifizierung - Biomarker

Key words:

acute kidney injury - prevention - risk stratification - biomarker

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