Abstract
Disease states involving both, cardial and renal function have been defined as separate entity called cardiorenal (reno-cardial) syndromes type 1 – 5. Due to the underlying disease this syndrome is increasingly common amongst the ageing population on the western world and makes physicians facing complex interactions of cardiological and nephrological therapy. Therapeutic approaches include the careful assessment of cardiovascular risk factors and the optimized therapy of both, cardiac and renal disease using so far evaluated strategies such as RAS-blockade, diuretic therapy and in distinct stages also extracorporeal fluid removal by ultrafiltration in the acute and peritoneal dialysis in the chronically unstable patient.
Kernaussagen
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Die gegenseitige Beeinflussung von Herz- und Nierenerkrankungen spiegelt sich in der Definition des kardiorenalen Syndroms (KRS) wider (Tab. [1]). Das KRS ist im klinischen Alltag häufig und bedarf einer interdisziplinären Therapie.
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Die akute Nierenschädigung wird derzeit anhand des Verlaufs von Serumkreatinin und Urinausscheidung in die RIFLE-Stadien eingeteilt (Tab. [2]). Grundlage für die Definition einer chronischen Nierenschädigung bzw. Funktionseinschränkung ist entweder der Nachweis einer reduzierten geschätzten glomerulären Filtrationsrate („estimated GFR”) über mehr als 3 Monate oder aber der Nachweis renaler Schäden bei normaler eGFR (z. B. Proteinurie oder nephritisches Sediment).
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Beim KRS werden 5 Typen unterschieden: Bei den Typen 1 und 2 führt eine akute (Typ 1) oder chronische (Typ 2) Herzerkrankung zur Verschlechterung der Nierenfunktion, bei den Typen 3 und 4 führt eine akute (Typ 3) oder chronische (Typ 4) Nierenfunktionseinschränkung zur Störung der kardialen Funktion und beim Typ 5 sind es systemische Krankheitsbilder, die zur kardialen und renalen Funktionsstörung führen. Bei den chronischen Formen (Typ 2 und 4) ist es dabei oft schwierig zu unterscheiden, ob die Herz- oder die Nierenerkrankung das primäre Problem waren.
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Therapeutisch gelten beim KRS die Regeln der Behandlung kardialer bzw. renaler Krankheitsbilder. Dabei sind die Diuretikatherapie und die RAAS-Blockade die wichtigsten Therapieoptionen. Eine akut eingeschränkte myokardiale Funktion muss vorrangig behandelt werden – im Zweifelsfall auch ohne Rücksicht auf die Nierenfunktion.
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PD Dr. med. Bernd Hohenstein
Bereich Nephrologie
Medizinische Klinik III
Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
Fetscherstr. 74
01307 Dresden
Phone: 0351-458-18639
Fax: 0351-458-5333
Email: bernd.hohenstein@uniklinikum-dresden.de
