Diagnostik und Pathophysiologie der akuten Nierenschädigung / des akuten Nierenversagens – Prävention möglich?

Zusammenfassung

Die akute Schädigung der Niere ist ein zunehmendes Problem in der ambulanten uns stationären Therapie von Patienten, insbesondere im Bereich der Intensivmedizin. Eine neue Definition und neue Biomarker sollen zu einer frühzeitigen Identifizierung von Risikopatienten und/oder Patienten mit bereits erfolgter Nierenschädigung führen, um ein Versagen der Nieren - also die Notwendigkeit einer Nierenersatztherapie zu reduzieren. Eine spezifische Therapie gibt es derzeit nicht, dennoch ist eine konsequente Vermeidung von Einflussfaktoren die die Niere schädigen, von nephrotoxischen Medikamenten bis zur protrahierten Hypotension, essentieller Bestandteil der Versorgung dieser Patienten. Einer der wichtigsten Faktoren zur Prävention und erfolgreichen Therapie ist das Vorhandensein klinisch-nephrologischer Expertise, die jedoch immer seltener anzutreffen ist.

Abstract

Acute kidney injury (AKI) in critically ill patients is on a dramatic rise. The same holds true for community acquired AKI. Two main mechanisms are responsible for this increase: the rising prevalence of chronic kidney disease and the progress in diagnostic and therapeutic procedures pushing the limits of impossible. Several new biomarkers have not only helped to identify patients at risk for AKI and diagnosing AKI within hours after the insult, they also helped improve our pathophysiological understanding of AKI. The increase in AKI and new diagnostic markers of it is currently not matched by an increase in prophylactic or therapeutic interventions. It is quite the opposite. For decades we have seen spectacular effects of new drugs and interventions in the preclinical setting, always followed by a miserable failure at the bedside. It seems that one non-pharmacological intervention, i. e. the human resource of being educated in nephrology might be of importance not only for those suffering from AKI in the intensive care unit but also for those surviving it. This comes to no surprise if one considers acute and chronic kidney diseases not as separate entities but rather as closely interconnected.

Schlüsselwörter

akutes Nierenversagen - Biomarker - Nephrologie

Key Words

acute kidney injury - biomarkers - nephrology

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