Die kardio-renale Achse: Physiologie, Pathophysiologie und klinische Relevanz?

Zusammenfassung

Seit langem ist bekannt, dass Änderungen des intrathorakalen und atrialen Blutvolumens Einfluss auf die Nierenfunktion nehmen. Interessanterweise wird diesem Mechanismus im intensivmedizinischen und anästhesiologischen Schrifttum nur untergeordnete Bedeutung beigemessen. Die vorliegende Übersichtsarbeit erläutert daher die Bedeutung kardiopulmonaler und arterieller Barorezeptoren für die Regulation der Nierenfunktion sowie die humoralen und nervalen Verknüpfungen der sogenannten „kardio-renalen Achse”. Darüber hinaus wird die klinische Relevanz dieser Mechanismen im intensivmedizinischen Kontext erörtert und das Konzept der Prophylaxe und Behandlung des akuten Nierenversagens mit diuretisch wirksamen Substanzen kritisch hinterfragt.

Abstract

It has been known for years that variations in atrial stretch and intrathoracic blood volume may affect kidney function. Interestingly, little information on this topic can be found in the recent literature of critical care medicine and anesthesiology. Hence, this review focusses on the role of low pressure cardiopulmonary and arterial baroreceptors in the regulation of kidney function and the neuro-endocrine mechanisms behind the so-called “cardio-renal axis”. The physiological mechanisms presented in this review may have clinical impact with regard to strategies for the prevention and treatment of acute renal failure and question the usefulness of diuretics to improve kidney function during several shock states.

Schlüsselwörter

Kardio-renale Integration - Barorezeptoren - Nierenfunktion - Regulation des Blutvolumen - Akutes Nierenversagen

Key words

Cardio-renal integration - Baroreceptors - Renal function - Regulation of blood volume - Acute renal failure

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