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Hepatorenales Syndrom

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Weiterbildung Anästhesiologie

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Zusammenfassung

Das hepatorenale Syndrom (HRS) umschreibt ein Nierenversagen, das bei Patienten mit fortgeschrittener Leberzirrhose im Zusammenhang mit einer Beeinträchtigung der systemischen Zirkulation auftritt. Die Inzidenz des HRS beträgt bei Patienten mit Aszites 8%; die Gesamthäufigkeit des Nierenversagens beträgt in der Endphase des Leberversagens 75%. Als ursächlich wird ein Fortschreiten der bei Lebererkrankungen auftretenden arteriellen Vasodilatation im Splanchnikusstromgebiet zusammen mit einer Verringerung des Herzzeitvolumens (HZV) angesehen. Es existieren 2 Typen des HRS: Beim HRS-Typ 1 kommt es zu einem schnellen Nierenversagen, das oftmals im Zusammenhang einer spontan-bakteriellen Peritonitis (SBP) auftritt und zügig in ein Multiorganversagen übergehen kann. Der HRS-Typ 2 ist durch eine langsame Entwicklung des Nierenversagens, zusammen mit der Zunahme des Aszites, gekennzeichnet. Die Prognose ist beim HRS-Typ 1 am schlechtesten. Die vorhandenen Therapieoptionen beim HRS (u. a. Gabe von Vasokonstriktoren und Albumin, Anlage eines transjugulären intrahepatischen Shunt, TIPS) können die Überlebensrate nur teilweise verbessern; die einzige definitive Behandlung stellt die Lebertransplantation dar.

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Leipzig

    G. Huschak, U.X. Kaisers & S. Laudi

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  1. G. Huschak
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  2. U.X. Kaisers
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  3. S. Laudi
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Huschak, G., Kaisers, U., Laudi, S. (2015). Hepatorenales Syndrom. In: Weiterbildung Anästhesiologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46515-8_1

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  • DOI: https://doi.org/10.1007/978-3-662-46515-8_1

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-46514-1

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