Epidemiologie und Ursachen für ein akutes Nierenversagen – Übergang in eine chronische Nierenschädigung

Die Grenzen verschwimmen schnell, wenn es um die ANV-Klassifikation geht, insbesondere zwischen prärenalen und renalen Ursachen. Es besteht ein enger Zusammenhang zwischen Mortalität und chronischer Nierenerkrankung. Aufgrund der hohen Inzidenz sollte ein ANV von klinisch tätigen Ärzten unmittelbar erkannt und ätiologisch eingeordnet werden können. Dieser Beitrag soll einen Überblick über die häufigsten Gründe eines ANV geben.

Abstract

Acute kidney injury (AKI) refers to an acute functional deterioration of the kidneys, which leads to retention of urinary substances, dysregulation of the electrolyte and acid-base balance, and disturbance of fluids. Although didactically helpful, the oversimplified AKI classification of prerenal/renal/postrenal is currently considered obsolete. Indeed, the boundaries blur quite quickly, particularly between prerenal and renal causes. Based on the AKI pathophysiology, it can be etiologically divided into decreased renal perfusion, postrenal obstruction and kidney specific injury or unspecific injury. AKI is a common event in hospitalized patients and associates strongly with mortality and chronic kidney disease (CKD). Today it is accepted that AKI and CKD are rather an individually variable continuum, than 2 distinct entities. If AKI has not regressed after 7 days, it is referred to as acute kidney disease (AKD). Persisting AKD for > 90 days is classified as CKD. The transition from AKD to CKD is the result of an incomplete and maladaptive repair process. Although follow-up of post-AKI patients is essential, optimal concepts still need to be developed.

Schlüsselwörter

akutes Nierenversagen - akute Nierenschädigung - akute Nierenerkrankung

Key words

acute renal failure - acute kidney injury - acute kidney disease

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