Dtsch Med Wochenschr 2021; 146(15): 977-981
DOI: 10.1055/a-1267-0733
Klinischer Fortschritt
Intensivmedizin

Volumentherapie und Nierenschädigung – was gibt es Neues?

Intravenous fluid therapy and acute kidney injury – What’s new?
Carsten Willam
  Medizinische Klinik 4, Universitätsklinikum Erlangen
,
Gunnar Schley
  Medizinische Klinik 4, Universitätsklinikum Erlangen
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Was ist neu?

Welche Menge an Volumenersatzstoff geben? Im Schock erfolgt die Flüssigkeitstherapie mit Kristalloiden nach zielgerichteten Kriterien und unter Kontrolle des Laktats. Zur Wiederherstellung des Reäquilibriums ist oft eine Negativbilanz durch Flüssigkeitsrestriktion, Schleifendiuretika und maschinelle Ultrafiltration erforderlich. Bei einer maschinellen Ultrafiltration sollten 1,75 ml/kg/h nicht überschritten werden.

Welche Volumenersatzstoffe geben? Balancierte Kristalloide sind Mittel der Wahl zur Flüssigkeitstherapie. Neue Volumenersatzstoffe mit einer höheren Anionenlücke haben einen alkalisierenden Effekt und können möglicherweise die Flüssigkeitstherapie optimieren.

Welche Volumenersatzstoffe führen zu AKI? Kochsalz führt aufgrund einer hyperchlorämischen Azidose in moderaten Mengen zu einer funktionellen Einschränkung der renalen Filtration. In höheren Mengen ist NaCl mit einem schlechten Outcome vergesellschaftet. HES und vermutlich auch Gelatine haben zytotoxische Effekte und können zu einer akuten Nierenschädigung führen.

Abstract

Optimization of intravascular volume is crucial for patients who are at risk or undergo Acute Kidney Injury. In sepsis or after acute fluid loss extensive fluid expansion is mostly needed. However, in cardiorenal syndroms fluid overload can even lead to AKI itself and reduction of intravascular volume is needed. Thus, an individualized fluid guidance in terms of a „fluid management stewartship“ for the right patient, the right drug, the right route and the right dose [1] has to be applied.

Schlüsselwörter

Flüssigkeitstherapie - akute Nierenschädigung - Kochsalz - Albumin

Key words

fluid therapy - acute kidney injury - critical care - saline - albumine


Publication History

Article published online:
03 August 2021

© 2021. Thieme. All rights reserved.

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