Der Anaesthesist

, Volume 58, Issue 8, pp 829–849 | Cite as

Akute perioperative Störungen der Nierenfunktion

Strategien zur Prävention und Therapie
CME - Weiterbildung - Zertifizierte Fortbildung

Zusammenfassung

Die zunehmende Lebenserwartung in den Industrienationen lässt die Zahl der Krankenhausbehandlungen alter und hoch betagter Menschen steigen. Immer häufiger werden auch komplexe Operationen bei diesen Patienten durchgeführt. Nierenfunktionsstörungen in der perioperativen Situation sind mit einer erheblichen Morbiditäts- und Letalitätsrate verbunden. Eine akute Nierenschädigung, im neueren Sprachgebrauch eine „acute kidney injury“ (AKI), ist bei kritisch kranken Patienten nahezu immer Bestandteil eines Multiorgandysfunktionssyndroms (MODS). Die Behandlungsstrategie sollte sich am Grad der Organfunktionsstörung orientieren. Meist ist aber das Stadium der Funktionsstörung nicht bekannt, und so wird oft das therapeutisch nutzbare Intervall verpasst. Nahezu regelhaft findet bei allen Patienten die gleiche Therapie Anwendung: Flüssigkeitszufuhr und Diuretikumgabe – häufig unter der Vorstellung: „Die Nieren müssen gespült werden!“. Eine vereinheitlichende Klassifikation des Kontinuums der Nierenfunktionsstörungen anhand der RIFLE-Kriterien („risk, injury, failure, loss, endstage kidney disease“) kann helfen, Frühphasen der Nierenfunktionsstörung zu erkennen, um entsprechend therapeutisch reagieren zu können, und den Einsatz konservativer Behandlungsstrategien kritisch zu hinterfragen bzw. zu optimieren.

Schlüsselwörter

Entstehungsmechanismus RIFLE-Kriterien Diuretika Flüssigkeitszufuhr Volumentherapie 

Acute perioperative disturbances of renal function

Strategies for prevention and therapy

Abstract

The increasing life expectancy in industrial nations leads to an increase in the number of elderly and aged persons treated in hospital. Increasingly more complex operations are being carried out on this group of patients. Renal dysfunction in the preoperative situation increases morbidity and mortality. Acute kidney injury (AKI) is nearly always part of a multi-organ dysfunction syndrome in critically ill patients. The treatment strategy of the AKI should be oriented to the degree of organ dysfunction. However, the stage of organ dysfunction is mostly unknown so that the therapeutically exploitable interval is often missed. The same therapy is practically always used for all patients: administration of fluids and diuretics often under the premise of“the kidneys must be rinsed”. A unified classification of the continuation of kidney function disorders using the RIFLE criteria (risk, injury, failure, loss, endstage kidney disease) can assist recognition of early stages of kidney failure in order to react correspondingly with therapeutic measures and to critically question or optimize the use of conservative treatment strategies.

Keywords

Causal mechanism RIFLE criteria Diuretics Fluid administration Volume therapy 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Klinik für Anästhesiologie und Operative IntensivmedizinKlinikum AugsburgAugsburgDeutschland

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