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Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51(11/12): 698-706
DOI: 10.1055/s-0042-101442
Fachwissen: Topthema
Anästhesiologie / Intensivmedizin
© Georg Thieme Verlag Stuttgart · New York

Akute Nierenschädigung - Stellenwert von Biomarkern bei perioperativen und intensivmedizinischen Patienten

Acute kidney injury – status of biomarkers in perioperative and critically ill patients
Anja Haase-Fielitz
1   Institut für Sozialmedizin und Gesundheitsökonomie, Otto-von-Guericke Universität Magdeburg
2   Prodekanat für Forschung und Wissenschaft der Medizinischen Hochschule Brandenburg
,
Michael Haase
3   Universitätsklinik für Nieren- und Hochdruckkrankheiten, Diabetologie und Endokrinologie
› Author Affiliations
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Publication History

Publication Date:
24 November 2016 (online)

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Die akute Nierenschädigung beeinträchtigt auch bei scheinbar mildem Verlauf und scheinbar vollständiger Erholung der Nierenfunktion die Kurz- und Langzeitprognose betroffener Patienten, ist aber prinzipiell therapeutisch beeinflussbar. Je größer das Zeitfenster zwischen dem Primärereignis und der Nierenfunktionserholung ist, desto schlechter ist die Prognose. Als wirksame Gegenmaßnahmen werden in Leitlinien die Frühdiagnose und die rasche, multifaktorielle Therapieeinleitung empfohlen, um die auslösenden und unterhaltenden nierenschädlichen Faktoren zu identifizieren und optimale Bedingungen für eine vollständige oder weitgehende Nierenerholung zu schaffen. Verschiedene Maßnahmen sind verfügbar, um eine akute Nierenschädigung bei perioperativen und intensivmedizinischen Patienten frühzeitig zu erkennen und die Behandlung einzuleiten.

Abstract

Acute kidney injury (AKI) impairs short- and long-term prognosis of affected patients even in case of apparantly mild course and ‚full’ recovery as measured by follow-up serum creatinine concentrations. Late or none intervention worsens prognosis. However, there are modifiable factors potentially contributing to preserved long-term renal function. Effective treatment is multifactorial and includes identification and reversal of AKI etiology and generation of a (micro)environment for optimal renal recovery. Available treatment options for AKI in perioperative and critically ill patients will be discussed in the setting of novel kidney biomarkers.

Kernaussagen

  • Die akute Nierenschädigung (AKI) ist ein häufiges Krankheitsbild perioperativer und intensivmedizinischer Patienten mit langfristigen renalen und kardiovaskulären Folgeerkrankungen, einer zumindest ebenso schlechten Prognose wie des Myokardinfarkts und hohen Kosten für das Gesundheitssystem.

  • Die frühe Diagnosestellung und zeitnahe Versorgung sowie die konsequente Nachsorge dieser Patienten gelten als Voraussetzung für die Primärprävention einer chronischen Niereninsuffizienz.

  • Serumkreatininanstieg- bzw. Diureserückgang-basierte Frühwarnsysteme oder neue renale Biomarker können bei der raschen Diagnosestellung hilfreich sein.

  • Gängige Behandlungsmaßnahmen können auf der Grundlage klassischer und unter Einbeziehung neuer renaler Biomarker eingeleitet werden.

Schlüsselwörter:

akute Nierenschädigung - Frühwarnsystem - Cystatin C - NGAL - TIMP-2*IGFBP7

Keywords:

acute kidney injury - eAlert - Cystatin C - NGAL - TIMP-2*IGFBP7
 

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