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Dialyse aktuell 2019; 23(10): 443-452
DOI: 10.1055/a-1007-0593
Schwerpunkt | Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Detektion und Differenzialdiagnose des ANV in der Intensivmedizin

Grundlagen und Hintergründe
Michael Jahn
1   Klinik für Nephrologie, Universitätsklinikum Essen, Universität Duisburg-Essen
,
Kristina Boss
1   Klinik für Nephrologie, Universitätsklinikum Essen, Universität Duisburg-Essen
,
Andreas Kribben
1   Klinik für Nephrologie, Universitätsklinikum Essen, Universität Duisburg-Essen
› Author Affiliations
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Publication History

Publication Date:
18 December 2019 (online)

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ZUSAMMENFASSUNG

Das akute Nierenversagen (ANV) in der Intensivmedizin ist typischerweise die Folge einer schweren Minderperfusion der Nieren, welche nach Ereignissen wie Sepsis, Trauma oder großen Operationen auftritt. Davon abzugrenzen sind seltenere ANV-Formen wie Glomerulonephritiden, interstitielle Nephritiden oder thrombotische Mikroangiopathien, für die es spezifische Therapieoptionen gibt. Abhängig von der Komorbidität des Patienten, geht das Krankheitsbild zumeist mit multiplen Organdysfunktionen einher und zeigt komplikationsreiche Verläufe mit einer hohen Mortalität. Der Einsatz neuer Biomarker ermöglicht ein früheres und sensitiveres Erkennen einer Nierenfunktionsstörung und/oder einer Nierenschädigung. Für die ANV-Diagnose gilt jedoch weiterhin die etablierte Definition nach den KDIGO-Kriterien.

 

  • Literatur

  • 1 Ostermann ME, Taube D, Morgan CJ, Evans TW. Acute renal failure following cardiopulmonary bypass: a changing picture. Intensive Care Med 2000; 26: 565-571 doi:10.1007/s001340051205
    CrossrefPubMedGoogle Scholar
  • 2 Chertow GM, Burdick E, Honour M. et al Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005; 16: 3365-3370 doi:10.1681/ASN.2004090740
    CrossrefPubMedGoogle Scholar
  • 3 Kellum JA, Levin N, Bouman C, Lameire N. Developing a consensus classification system for acute renal failure. Curr Opin Crit Care 2002; 8: 509-514
    CrossrefPubMedGoogle Scholar
  • 4 KDIGO AKI Work Group KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2: 1-138
    CrossrefGoogle Scholar
  • 5 Liborio AB, Leite TT, Neves FM. et al AKI complications in critically ill patients: association with mortality rates and RRT. Clin J Am Soc Nephrol 2015; 10: 21-28 doi:10.2215/CJN.04750514
    CrossrefPubMedGoogle Scholar
  • 6 Hoste EA, Bagshaw SM, Bellomo R. et al Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 2015; 41: 1411-1423 doi:10.1007/s00134-015-3934-7
    CrossrefPubMedGoogle Scholar
  • 7 Kellum JA, Sileanu FE, Murugan R. et al Classifying AKI by Urine Output versus Serum Creatinine Level. J Am Soc Nephrol 2015; 26: 2231-2238 doi:10.1681/ASN.2014070724
    CrossrefPubMedGoogle Scholar
  • 8 Fortrie G, de Geus HRH, Betjes MGH. The aftermath of acute kidney injury: a narrative review of long-term mortality and renal function. Crit Care 2019; 23: 24 doi:10.1186/s13054-019-2314-z
    CrossrefPubMedGoogle Scholar
  • 9 Giordana F, D’Ascenzo F, Nijhoff F. et al Meta-analysis of predictors of all-cause mortality after transcatheter aortic valve implantation. Am J Cardiol 2014; 114: 1447-1455 doi:10.1016/j.amjcard.2014.07.081
    CrossrefPubMedGoogle Scholar
  • 10 Mao H, Katz N, Ariyanon W. et al Cardiac surgery-associated acute kidney injury. Cardiorenal Med 2013; 3: 178-199 doi:10.1159/000353134
    CrossrefPubMedGoogle Scholar
  • 11 Lai CF, Wu VC, Huang TM. et al Kidney function decline after a non-dialysis-requiring acute kidney injury is associated with higher long-term mortality in critically ill survivors. Crit Care 2012; 16: R123 doi:10.1186/cc11419
    CrossrefPubMedGoogle Scholar
  • 12 Brown JR, Parikh CR, Ross CS. et al Impact of perioperative acute kidney injury as a severity index for thirty-day readmission after cardiac surgery. Ann Thorac Surg 2014; 97: 111-117 doi:10.1016/j.athoracsur.2013.07.090
    CrossrefPubMedGoogle Scholar
  • 13 Sawhney S, Marks A, Fluck N. et al Intermediate and Long-term Outcomes of Survivors of Acute Kidney Injury Episodes: A Large Population-Based Cohort Study. Am J Kidney Dis 2017; 69: 18-28 doi:10.1053/j.ajkd.2016.05.018
    CrossrefPubMedGoogle Scholar
  • 14 See EJ, Jayasinghe K, Glassford N. et al Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int 2019; 95: 160-172 doi:10.1016/j.kint.2018.08.036
    CrossrefPubMedGoogle Scholar
  • 15 Gocze I, Schlitt HJ, Bergler T. Biomarker-guided Intervention to Prevent AKI or KDIGO Care Bundle to Prevent AKI in High-risk Patients Undergoing Major Surgery?. Ann Surg 2018; 268: e68-e69 doi:10.1097/SLA.0000000000002635
    CrossrefPubMedGoogle Scholar
  • 16 Hobson C, Ozrazgat-Baslanti T, Kuxhausen A. et al Cost and Mortality Associated With Postoperative Acute Kidney Injury. Ann Surg 2015; 261: 1207-1214 doi:10.1097/SLA.0000000000000732
    CrossrefPubMedGoogle Scholar
  • 17 Mehta RL, Pascual MT, Soroko S. et al Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int 2004; 66: 1613-1621 doi:10.1111/j.1523-1755.2004.00927.x
    CrossrefPubMedGoogle Scholar
  • 18 Santos WJ, Zanetta DM, Pires AC. et al Patients with ischaemic, mixed and nephrotoxic acute tubular necrosis in the intensive care unit--a homogeneous population?. Crit Care 2006; 10: R68 doi:10.1186/cc4904
    CrossrefPubMedGoogle Scholar
  • 19 Liano F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 1996; 50: 811-818 doi:10.1038/ki.1996.380
    CrossrefPubMedGoogle Scholar
  • 20 Guder WG, Ross BD. Enzyme distribution along the nephron. Kidney Int 1984; 26: 101-111 doi:10.1038/ki.1984.143
    CrossrefPubMedGoogle Scholar
  • 21 Brealey D, Brand M, Hargreaves I. et al Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet 2002; 360: 219-223 doi:10.1016/S0140-6736(02)09459-X
    CrossrefPubMedGoogle Scholar
  • 22 Carre JE, Orban JC, Re L. et al Survival in critical illness is associated with early activation of mitochondrial biogenesis. Am J Respir Crit Care Med 2010; 182: 745-751 doi:10.1164/rccm.201003-0326OC
    CrossrefPubMedGoogle Scholar
  • 23 Carlstrom M, Wilcox CS, Arendshorst WJ. Renal autoregulation in health and disease. Physiol Rev 2015; 95: 405-511 doi:10.1152/physrev.00042.2012
    CrossrefPubMedGoogle Scholar
  • 24 Verma SK, Molitoris BA. Renal endothelial injury and microvascular dysfunction in acute kidney injury. Semin Nephrol 2015; 35: 96-107 doi:10.1016/j.semnephrol.2015.01.010
    CrossrefPubMedGoogle Scholar
  • 25 Meola M, Nalesso F, Petrucci I. et al Clinical Scenarios in Acute Kidney Injury: Pre-Renal Acute Kidney Injury. Contrib Nephrol 2016; 188: 21-32 doi:10.1159/000445462
    PubMedGoogle Scholar
  • 26 Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med 1996; 334: 1448-1460 doi:10.1056/NEJM199605303342207
    CrossrefPubMedGoogle Scholar
  • 27 Herget-Rosenthal S, Hosford M, Kribben A. et al Characteristics of EYFP-actin and visualization of actin dynamics during ATP depletion and repletion. Am J Physiol Cell Physiol 2001; 281: C1858-C1870 doi:10.1152/ajpcell.2001.281.6.C1858
    CrossrefPubMedGoogle Scholar
  • 28 Molitoris BA, Sutton TA. Endothelial injury and dysfunction: role in the extension phase of acute renal failure. Kidney Int 2004; 66: 496-499 doi:10.1111/j.1523-1755.2004.761_5.x
    CrossrefPubMedGoogle Scholar
  • 29 Knaus WA, Draper EA, Wagner DP. et al APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-829
    CrossrefPubMedGoogle Scholar
  • 30 Knaus WA, Wagner DP, Draper EA. et al The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100: 1619-1636 doi:10.1378/chest.100.6.1619
    CrossrefPubMedGoogle Scholar
  • 31 Le JR Gall, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270: 2957-2963 doi:10.1001/jama.270.24.2957
    CrossrefPubMedGoogle Scholar
  • 32 Metnitz PG, Moreno RP, Almeida E. et al SAPS 3 – From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description. Intensive Care Med 2005; 31: 1336-1344 doi:10.1007/s00134-005-2762-6
    CrossrefPubMedGoogle Scholar
  • 33 Lemeshow S, Teres D, Klar J. et al Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA 1993; 270: 2478-2486
    CrossrefPubMedGoogle Scholar
  • 34 Higgins TL, Teres D, Copes WS. et al Assessing contemporary intensive care unit outcome: an updated Mortality Probability Admission Model (MPM0-III). Crit Care Med 2007; 35: 827-835 doi:10.1097/01.CCM.0000257337.63529.9F
    CrossrefPubMedGoogle Scholar
  • 35 Cao Z, Jia Y, Zhu B. BNP and NT-proBNP as Diagnostic Biomarkers for Cardiac Dysfunction in Both Clinical and Forensic Medicine. Int J Mol Sci 2019: 20 pii: E1820. doi:10.3390/ijms20081820
    PubMedGoogle Scholar
  • 36 Januzzi JL, van Kimmenade R, Lainchbury J. et al NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study. Eur Heart J 2006; 27: 330-337 doi:10.1093/eurheartj/ehi631
    CrossrefPubMedGoogle Scholar
  • 37 Ferguson ND, Fan E, Camporota L. et al The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 2012; 38: 1573-1582 doi:10.1007/s00134-012-2682-1
    CrossrefPubMedGoogle Scholar
  • 38 Rubin TM, Heyne K, Luchterhand A. et al Kinetic validation of the LiMAx test during 10 000 intravenous (13)C-methacetin breath tests. J Breath Res 2017; 12: 016005 doi:10.1088/1752-7163/aa820b
    CrossrefPubMedGoogle Scholar
  • 39 Havasi A, Borkan SC. Apoptosis and acute kidney injury. Kidney Int 2011; 80: 29-40 doi:10.1038/ki.2011.120
    CrossrefPubMedGoogle Scholar
  • 40 Kelly KJ. Distant effects of experimental renal ischemia/reperfusion injury. J Am Soc Nephrol 2003; 14: 1549-1558 doi:10.1097/01.asn.0000064946.94590.46
    CrossrefPubMedGoogle Scholar
  • 41 Kinsey GR, Li L, Okusa MD. Inflammation in acute kidney injury. Nephron Exp Nephrol 2008; 109: e102-e107 doi:10.1159/000142934
    CrossrefPubMedGoogle Scholar
  • 42 Feltes CM, Van Eyk J, Rabb H. Distant-organ changes after acute kidney injury. Nephron Physiol 2008; 109: p80-p84 doi:10.1159/000142940
    CrossrefPubMedGoogle Scholar
  • 43 Bellomo R, Ronco C, Kellum JA. et al Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8: R204-212 doi:10.1186/cc2872
    CrossrefPubMedGoogle Scholar
  • 44 Ronco C. Acute kidney injury: from clinical to molecular diagnosis. Critical Care 2016; 20: 201 doi:10.1186/s13054-016-1373-7
    CrossrefPubMedGoogle Scholar
  • 45 Mehta RL, Kellum JA, Shah SV. et al Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31 doi:10.1186/cc5713
    CrossrefPubMedGoogle Scholar
  • 46 Kim H, Hur M, Cruz DN. et al Plasma neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in critically ill patients with suspected sepsis. Clin Biochem 2013; 46: 1414-1418 doi:.1016/j.clinbiochem.2013.05.069
    CrossrefPubMedGoogle Scholar
  • 47 Hoste EA, McCullough PA, Kashani K. et al Derivation and validation of cutoffs for clinical use of cell cycle arrest biomarkers. Nephrol Dial Transplant 2014; 29: 2054-2061 doi:10.1093/ndt/gfu292
    CrossrefPubMedGoogle Scholar
  • 48 Gunnerson KJ, Shaw AD, Chawla LS. et al TIMP2*IGFBP7 biomarker panel accurately predicts acute kidney injury in high-risk surgical patients. J Trauma Acute Care Surg 2016; 80: 243-249 doi:10.1097/TA.0000000000000912
    CrossrefPubMedGoogle Scholar
  • 49 Vijayan A, Faubel S, Askenazi DJ. et al Clinical Use of the Urine Biomarker [TIMP-2] × [IGFBP7] for Acute Kidney Injury Risk Assessment. Am J Kidney Dis 2016; 68: 19-28 doi:10.1053/j.ajkd.2015.12.033
    CrossrefPubMedGoogle Scholar
  • 50 Kashani K, Al-Khafaji A, Ardiles T. et al Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury. Crit Care 2013; 17: R25 doi:10.1186/cc12503
    CrossrefPubMedGoogle Scholar
  • 51 de Geus HR, Ronco C, Haase M. et al The cardiac surgery-associated neutrophil gelatinase-associated lipocalin (CSA-NGAL) score: A potential tool to monitor acute tubular damage. J Thorac Cardiovasc Surg 2016; 151: 1476-1481 doi:10.1016/j.jtcvs.2016.01.037
    CrossrefPubMedGoogle Scholar
  • 52 Schunk SJ, Zarbock A, Meersch M. et al Association between urinary dickkopf-3, acute kidney injury, and subsequent loss of kidney function in patients undergoing cardiac surgery: an observational cohort study. Lancet 2019; 394: 488-496 doi:10.1016/S0140-6736(19)30769-X
    CrossrefPubMedGoogle Scholar
  • 53 Ronco C. Acute kidney injury: from clinical to molecular diagnosis. Crit Care 2016; 20: 201 doi:10.1186/s13054-016-1373-7
    CrossrefPubMedGoogle Scholar
  • 54 Han SS, Ahn SY, Ryu J. et al Proteinuria and hematuria are associated with acute kidney injury and mortality in critically ill patients: a retrospective observational study. BMC Nephrol 2014; 15: 93 doi:10.1186/1471-2369-15-93
    CrossrefPubMedGoogle Scholar
  • 55 Dickson LE, Wagner MC, Sandoval RM. et al The proximal tubule and albuminuria: really!. J Am Soc Nephrol 2014; 25: 443-453 doi:10.1681/ASN.2013090950
    CrossrefPubMedGoogle Scholar
  • 56 Parikh CR, Lu JC, Coca SG. et al Tubular proteinuria in acute kidney injury: a critical evaluation of current status and future promise. Ann Clin Biochem 2010; 47: 301-312 doi:10.1258/acb.2010.010076
    CrossrefPubMedGoogle Scholar
  • 57 Jennette JC, Nachman PH. ANCA Glomerulonephritis and Vasculitis. Clin J Am Soc Nephrol 2017; 12: 1680-1691 doi:10.2215/cjn.02500317
    CrossrefPubMedGoogle Scholar
  • 58 Praga M, Sevillano A, Aunon P. et al Changes in the aetiology, clinical presentation and management of acute interstitial nephritis, an increasingly common cause of acute kidney injury. Nephrol Dial Transplant 2015; 30: 1472-1479 doi:10.1093/ndt/gfu326
    CrossrefPubMedGoogle Scholar
  • 59 Perazella MA. Diagnosing drug-induced AIN in the hospitalized patient: a challenge for the clinician. Clin Nephrol 2014; 81: 381-388 doi:10.5414/cn108301
    CrossrefPubMedGoogle Scholar
  • 60 Muriithi AK, Nasr SH, Leung N. Utility of urine eosinophils in the diagnosis of acute interstitial nephritis. Clin J Am Soc Nephrol 2013; 8: 1857-1862 doi:10.2215/CJN.01330213
    CrossrefPubMedGoogle Scholar
  • 61 Levy GG, Nichols WC, Lian EC. et al Mutations in a member of the ADAMTS gene family cause thrombotic thrombocytopenic purpura. Nature 2001; 413: 488-494 doi:10.1038/35097008
    CrossrefPubMedGoogle Scholar
  • 62 Buchholz U, Bernard H, Werber D. et al German outbreak of Escherichia coli O104:H4 associated with sprouts. N Engl J Med 2011; 365: 1763-1770 doi:10.1056/NEJMoa1106482
    CrossrefPubMedGoogle Scholar
  • 63 Noris M, Caprioli J, Bresin E. et al Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype. Clin J Am Soc Nephrol 2010; 5: 1844-1859 doi:10.2215/CJN.02210310
    CrossrefPubMedGoogle Scholar
  • 64 Clark WF. Thrombotic microangiopathy: current knowledge and outcomes with plasma exchange. Semin Dial 2012; 25: 214-219 doi:10.1111/j.1525-139X.2011.01035.x
    CrossrefPubMedGoogle Scholar
  • 65 Legendre CM, Licht C, Muus P. et al Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome. N Engl J Med 2013; 368: 2169-2181 doi:10.1056/NEJMoa1208981
    CrossrefPubMedGoogle Scholar
  • 66 Froissart A, Buffet M, Veyradier A. et al Efficacy and safety of first-line rituximab in severe, acquired thrombotic thrombocytopenic purpura with a suboptimal response to plasma exchange. Experience of the French Thrombotic Microangiopathies Reference Center. Crit Care Med 2012; 40: 104-111 doi:10.1097/CCM.0b013e31822e9d66
    CrossrefPubMedGoogle Scholar
  • 67 Lameire N, Vanholder R, Van Biesen W. et al Acute kidney injury in critically ill cancer patients: an update. Crit Care 2016; 20: 209 doi:10.1186/s13054-016-1382-6
    CrossrefPubMedGoogle Scholar
  • 68 Petejova N, Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. Crit Care 2014; 18: 224 doi:10.1186/cc13897
    CrossrefPubMedGoogle Scholar
  • 69 Bienholz A, Wilde B, Kribben A. From the nephrologist’s point of view: diversity of causes and clinical features of acute kidney injury. Clin Kidney J 2015; 8: 405-414 doi:10.1093/ckj/sfv043
    CrossrefPubMedGoogle Scholar