Nierenfunktionsstörungen durch Medikamente

Zusammenfassung

Das akute Nierenversagen (ANV) jeglicher Ursache ist eine häufige Erkrankung bei hospitalisierten Patienten mit signifikantem Anstieg von Mortalität, Morbidität sowie der Krankenhausverweildauer bzw. der Krankenhauskosten. Die medikamenteninduzierte Schädigung der Nierenfunktion tritt dabei primär in Patienten mit bestehenden Risikofaktoren wie präexistenter Niereninsuffizienz, Dehydratation/Hypotension, höherem Lebensalter oder Diabetes mellitus auf, wobei das auslösende Medikament bei umfangreichen Therapien mitunter schwer zu definieren ist. Pathophysiologisch tragen zu dieser Krankheitsentität hämodynamische Ursachen, intrinsische tubulointerstitielle Schädigungen sowie die intrarenale (tubuläre) Obstruktion durch Präzipitate bei, teils mit entsprechender klinischer Symptomatik. Klinisch steht das akute Nierenversagen einhergehend mit Hyperhydratation mit/ohne Lungenödem sowie fehlender Clearance von toxischen Metaboliten im Vordergrund. Bei insgesamt guter Prognose des medikamentös-toxischen ANVs, insbesondere bei frühzeitigem Absetzen des auslösenden Agens, sind dennoch immer wieder schwere Verläufe mit zum Teil chronischer Funktionsverschlechterung bis hin zur Dialysepflichtigkeit zu beobachten. Erkennen und Beachten von Risikofaktoren mit Identifikation von Risikopatienten kann helfen entsprechende Vorsichtsmaßnahmen zu veranlassen. Insbesondere in der Intensivmedizin sollte das Erkennen mit nachfolgender Prophylaxe essenzieller Bestandteil der täglichen Routine sein, da diese Patientengruppe typischerweise dem höchsten Risiko unterliegt.

Abstract

Acute kidney injury (AKI) of any origin is a common complication/disease in hospitalized patients, going along with significantly increased mortality and morbidity, as well as hospitalization duration and expenses. Drug-induced AKI is usually seen in patients with concurrent risk factors such as existing kidney disease, dehydration with or without hypotension, older age or diabetes mellitus. In cases with multiple risk factors or therapies the triggering drug is often impossible to define. Hemodynamic alterations, intrinsic tubulointerstitial damages and intrarenal (i. e. tubular) obstructions as a result of drug precipitations are the pathophysiological basis of this disease entity. Clinically the AKI is perceived as the most important problem, due to the development of hyperhydration (including pulmonary edema) and reduced/lacking clearance of toxic metabolites. The prognosis of drug-induced AKI is usually good, especially if the agents are stopped early in the process, but nevertheless some patients experience severe acute AKI requiring dialysis with/without subsequent restoration. Considering and recognizing potential risk factors may help to identify patients at risk and lead to introduction of prophylactic actions. Identification of risk factors and the introduction of prevention strategies should be an integral part of everybody's daily clinical work, especially in intensive care medicine due to the high susceptibility to AKI.

Schlüsselwörter

akutes Nierenversagen - akute Tubulusnekrose - NSAR - nephrotoxische Medikamente - Röntgenkontrastmittel

Keywords

acute kidney injury - acute tubulus necrosis - NSAID - nephrotoxic drugs - radiocontrast dye

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