PDF herunterladen
Dialyse aktuell 2014; 18(8): 416-422
DOI: 10.1055/s-0034-1395945
Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Das akute Nierenversagen in der Klinik – Grundlagen und Besonderheiten

Acute kidney injury in the hospital – Basics and specific features
Anja Bienholz
1   Klinik für Nephrologie, Universitätsklinikum Essen (AöR), Universität Duisburg-Essen, Essen (Direktor: Prof. Dr. Andreas Kribben)
,
Michael Jahn
1   Klinik für Nephrologie, Universitätsklinikum Essen (AöR), Universität Duisburg-Essen, Essen (Direktor: Prof. Dr. Andreas Kribben)
,
Andreas Kribben
1   Klinik für Nephrologie, Universitätsklinikum Essen (AöR), Universität Duisburg-Essen, Essen (Direktor: Prof. Dr. Andreas Kribben)
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
05. November 2014 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Das akute Nierenversagen (ANV) betrifft aufgrund seiner vielfältigen Auslöser und begünstigenden Faktoren alle medizinischen Fachbereiche. Im Rahmen eines Klinikaufenthalts wird der Patient, häufig vorbelastet durch Risikofaktoren wie Diabetes mellitus, chronische Nierenkrankheit oder Herzinsuffizienz, mit zusätzlichen Ereignissen konfrontiert, die das instabile renale Gleichgewicht stören und in einem ANV resultieren. Nur die ganzheitliche Betrachtung des ANV im Kontext der zugrunde liegenden Erkrankungsbilder ermöglicht Verbesserungen bei Prävention, Diagnostik und Therapie. Der vorliegende Artikel soll daher über die Besonderheiten des ANVs in Zusammenhang mit häufigen klinischen Krankheitsbildern wie Herz- und Leberinsuffizienz, Sepsis, Tumorerkrankungen sowie Leber- und Nierentransplantation informieren.

Acute kidney injury (AKI) is a syndrome with multiple triggers and factors increasing susceptibility occurring in all kind of medical settings. Patients who are often burdened by risk factors such as diabetes, chronic kidney disease or cardiac insufficiency are often faced with additional strains during the course of clinical treatments which disturb the instable renal balance and consequently lead to AKI. Only an integrated perspective of AKI in the context of the underlying disease allows improvements in preventive strategies, diagnostics and therapy. Therefore, the current article summarizes the specific features of AKI in relationship with frequent disorders such as heart and liver insufficiency, sepsis, cancer as well as liver and kidney transplantation.

Key words

acute kidney injury - hospital - risk factors - integrated perspective
 

  • Literatur

  • 1 Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney iInjury. Kidney Int Suppl 2012; 2: 1-138
    CrossrefGoogle Scholar
  • 2 Singbartl K, Kellum J. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int 2012; 81: 819-825
    CrossrefGoogle Scholar
  • 3 Lameire N, Bagga A, Cruz D et al. Acute kidney injury: an increasing global concern. Lancet 2013; 382: 170-179
    CrossrefGoogle Scholar
  • 4 Zeng X, McMahon G, Brunelli S et al. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol 2014; 9: 12-20
    CrossrefGoogle Scholar
  • 5 Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the problem?. Crit Care Med 2008; 36
    Google Scholar
  • 6 Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systemetic review and meta-analysis. Kidney Int 2012; 81: 442-448
    CrossrefPubMedGoogle Scholar
  • 7 Tsai TT, Patel UD, Chang TI et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv 2014; 7: 1-9
    Google Scholar
  • 8 Ronco C, House AA, Haapio M. Cardiorenal and renocardiac syndromes: the need for a comprehensive classification and consensus. Nat Clin Pract Nephrol 2008; 4: 310-311
    CrossrefGoogle Scholar
  • 9 Zannad F, Mebazaa A, Juillière Y et al. EFICA Investigators. Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study. Eur J Heart Fail 2006; 8: 697-705
    CrossrefGoogle Scholar
  • 10 Legrand M, Mebazaa A, Ronco C, Januzzi JJ. When cardiac failure, kidney dysfunction, and kidney injury intersect in acute conditions: the case of cardiorenal syndrome. Crit Care Med 2014; 42: 2109-2117
    CrossrefGoogle Scholar
  • 11 Aspromonte N, Cruz DN, Ronco C, Valle R. Role of bioimpedance vectorial analysis in cardio-renal syndromes. Semin Nephrol 2012; 32: 93-99
    CrossrefGoogle Scholar
  • 12 Feldkamp T, Kribben A. Contrast media induced nephropathy: definition, incidence, outcome, pathophysiology, risk factors and prevention. Minerva Med 2008; 99: 177-196
    Google Scholar
  • 13 Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol 2006; 1: 19-32
    CrossrefPubMedGoogle Scholar
  • 14 Lassnigg A, Schmidlin D, Mouhieddine M et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004; 15: 1597-1605
    CrossrefGoogle Scholar
  • 15 Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012; 81: 442-448
    CrossrefPubMedGoogle Scholar
  • 16 Bagshaw SM, Uchino S, Bellomo R et al. Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol 2007; 2: 431-439
    CrossrefPubMedGoogle Scholar
  • 17 Vieira Jr JM, Castro I, Curvello-Neto A et al. Effect of acute kidney injury on weaning from mechanical ventialtion in critically ill patients. Crit Care Med 2007; 35: 184-191
    CrossrefGoogle Scholar
  • 18 Metha RL, Bouchard J, Soroko SB et al. Program to Improve Care in Acute Renal Disease (PICARD) Study Group. Sepsis as a cause and consequence of acute kidney injury: Program to Improve Care in Acute Renal Disease. Intensive Care Med 2011; 37: 241-248
    CrossrefPubMedGoogle Scholar
  • 19 Prowle J, Kirwan C, Bellomo R. Fluid management for the prevention and attenuation of acute kidney injury. Nat Rev Nephrol 2014; 10: 37-47
    Google Scholar
  • 20 Sun Z, Ye H, Shen X et al. Continuous venovenous hemofiltration versus extended daily hemofiltration in patients with septic acute kidney injury: a retrospective cohort study. Crit Care 2014; 18
    Google Scholar
  • 21 Wald R, Shariff SZ, Adhikari NK et al. The association between renal replacement therapy modalityand long-term outcomes among critically ill adults with acute kidney injury: a retrospective cohort study. Crit Care Med 2014; 42: 868-877
    CrossrefGoogle Scholar
  • 22 Hutchison CA, Batuman V, Behrens J et al. International Kidney and Monoclonal Gammopathy Research Group. The pathogenesis and diagnosis of acute kidney injury in multiple myeloma. Nat Rev Nephrol 2011; 8: 43-45
    CrossrefGoogle Scholar
  • 23 Walther C, Podoll A, Finkel K. Treatment of acute kidney injury with cast nephropathy. Clin Nephrol 2014; 82: 1-6
    Google Scholar
  • 24 Abu-Alfa AK, Younes A. Tumor lysis syndrome and acute kidney injury: evaluation, prevention, and management. Am J Kidney Dis 2010; 55
    Google Scholar
  • 25 Fagundes C, Ginès P. Hepatorenal syndrome: a severe, but treatable, cause of kidney failure in cirrhosis. Am J Kidney Dis 2012; 59: 874-885
    CrossrefGoogle Scholar
  • 26 Møller S, Krag A, Bendtsen F. Kidney injury in cirrhosis: pathophysiological and therapeutic aspects of hepatorenal syndromes. Liver Int 2014; 34: 1153-1563
    CrossrefGoogle Scholar
  • 27 Gluud LL, Christensen K, Christensen E, Krag A. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010; 51: 576-584
    CrossrefGoogle Scholar
  • 28 Barbano B, Sardo L, Gigante A et al. Pathophysiology, diagnosis and clinical management of hepatorenal syndrome: from classic to new drugs. Curr Vasc Pharmacol 2014; 12: 125-135
    CrossrefGoogle Scholar
  • 29 Karapanagiotou A, Kydona C, Dimitriadis C et al. Acute kidney injury after orthotopic liver transplantation. Transplant Proc 2012; 44: 2727-2729
    CrossrefGoogle Scholar
  • 30 Saner FH, Treckmann JW, Geis A et al. Efficacy and safety of regional citrate anticoagulation in liver transplant patients requiring post-operative renal replacement therapy. Nephrol Dial Transplant 2012; 27: 1651-1657
    CrossrefGoogle Scholar
  • 31 Cooper JE, Wiseman AC. Acute kidney injury in kidney transplantation. Curr Opin Nephrol Hypertens 2013; 22: 698-703
    CrossrefGoogle Scholar
  • 32 Nakamura M, Seki G, Iwadoh K et al. Acute kidney injury as defined by the RIFLE criteria is a risk factor for kidney transplant graft failure. Clin Transplant 2011; 26: 520-528
    Google Scholar
  • 33 Mehrotra A, Rose C, Pannu N et al. Incidence and consequences of acute kidney injury in kidney transplant recipients. Am J Kidney Dis 2012; 59: 558-565
    CrossrefGoogle Scholar
  • 34 Bienholz A, Kribben A. KDIGO-Leitlinien zum akuten Nierenversagen. Der Nephrologe 2013; 8: 247-251
    CrossrefGoogle Scholar
  • 35 Ketteler M, Biggar P. Kardiorenales Syndrom. Der Nephrologe 2010; 5: 49-57
    CrossrefGoogle Scholar