Skip to main content
SpringerLink
Log in

Das Verhalten der Blut-Liquorgradienten bei Azotämie und ihre Beeinflussung durch die Hämodialyse

  • Originalien
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Zusammenfassung

An 26 Patienten mit akuter (13) und chronischer (13) Azotämie wurden die bei der Hämodialyse auftretenden Konzentrationsänderungen verschiedener dialysabler Substanzen, des Eiweißgehaltes und der Osmolalität im Plasma und Liquor cerebrospinalis untersucht. Die Mittelwerte der dialyseabhängigen Änderungen (±s) im Plasma und (Liquor) betrugen:

  1. 1.

    ΔHarnstoff: −212±49 (−59±37) mg-%.

  2. 2.

    ΔKreatinin: −9±5 (−2±5) mg-%.

  3. 3.

    ΔNatrium: +8,9±5,9 (−4,3±17,9) mval/l.

  4. 4.

    ΔChlorid: +11±15 (−4±16) mval/l.

  5. 5.

    ΔKalium: −1,3±0,6 (−0,2±0,4) maval/l.

  6. 6.

    ΔCalcium: +1,3±0,5 (0±0,3) mval/l.

  7. 7.

    ΔMagnesium: −0,18±0,2 (−0,1±0,3) mval/l.

  8. 8.

    ΔBicarbonat: +9,8±3,5 (−0,1±1,8) mval/l.

  9. 9.

    ΔEiweiß: +0,15±0,4 (+4,0±26,8)g-%/mg-%

  10. 10.

    ΔGlucose: +65±95 (+23±47) mg-%.

  11. 11.

    ΔOsmolalität: −20±11 (−11±13) mosm/l.

Im Gegensatz zu anderen Untersuchern fanden wir nach 5stündiger Dialysebehandlung keinen signifikanten osmotischen Gradienten zwischen Liquor und Plasma, der als Ursache eines Flüssigkeitseinstroms in den Liquorraum und damit einer intrakraniellen Drucksteigerung im Sinne des „cerebralen Dialysesyndroms“ angesehen werden könnte. Die möglichen Gründe für das Fehlen eines osmotischen Disäquilibriums in den vorliegenden Untersuchungen wie in der klinischen Erfahrung bei mehr als 500 Hämodialysen werden diskutiert. Weitere Beobachtungen an 10 Patienten zeigten, daß ein stärkerer Abfall der Blutosmolarität während der Hämodialyse durch Infusion hypertonischer Mannitlösung verhindert und damit die Möglichkeit ungünstiger osmotischer Verschiebungen ausgeschaltet werden kann.

Summary

In 26 patients with acute (13) and chronic (13) azotemia the concentration of various dialysable substances, the protein content and the osmolarity of plasma and spinal fluid were determined before and after a five hour hemodialysis period. The mean differences (± one standard deviation) in plasma and spinal fluid are summarized in table No. 2.

In contrast to other investigators after a five hour period of dialysis we did not find a significant osmotic gradient between spinal fluid and plasma that could be regarded a cause of fluid migration into the spinal fluid compartment and thus a cause of increased intracranial pressure in terms of a “cerebral dialysis syndrome.” Our investigations as well as our clinical experience with more than 500 hemodialyses suggest that the absence of osmotic disequilibrium in this study may be due to the fact that drastic changes of the chemical status were avoided by employing relatively short periods of dialysis at comparatively lower NPN levels.

Further observations in 10 patients showed that a greater decrease of serum osmolarity during hemodalysis can be avoided by the infusion of hypertonic mannitol solution, thus eliminating the danger of unwarranted osmotic derangements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Alwall, N.: Therapeutic and diagnostic problems in severe renal failure. Copenhagen-Stockholm-Oslo-Bergen 1963.

  2. Doyle, J. E.: Extracorporal hemodialysis therapy in blood chemistry disorders. Springfield (Ill.) 1962.

  3. Dossetor, J. B., J. H. Oh, L. Dayes, andH. M. Pappius: Brain urea and water changes with rapid hemodialysis of uremic dogs. Trans. Amer. Soc. Artif. Int. Organs10, 323 (1964).

    Google Scholar 

  4. Gilliland, K. G., andR. M. Hegstrom: The effect of hemodailysis on cerebrospinal fluid pressure in uramic dogs. Trans. Amer. Soc. Artif. Int. Organs9, 44 (1963).

    Google Scholar 

  5. Hamburger, J., etG. Richet: Le rein artificiel. Extrait des acquisitions médicales récentes. Paris: Méd. Flammarion 1956.

    Google Scholar 

  6. Jacob, J. C., P. Gloor, O. H. Elwan, J. B. Dossetor, andV. R. Pateras: Electroencephalographie changes in chronic renal failure. Neurology15, 419 (1965).

    Google Scholar 

  7. Javid, M., andM. S. Anderson: Effect of urea on cerebrospinal fluid pressure in monkeys before and after bilateral nephrectomy. J. Lab. clin. Med.53, 484 (1959).

    Google Scholar 

  8. Kennedy, A. C., A. L. Linton, andJ. C. Eaton: Urea levels in cerebrospinal fluid after hemodialysis. Lancet1962I, 410.

    Google Scholar 

  9. Kennedy, A. C., A. L. Linton, R. G. Luke, andS. Renfrew: Electroencephalographie changes during hemodialysis. Lancet1963I, 408.

    Google Scholar 

  10. Kennedy, A. C., A. L. Pinton, andA. J. Dinwoodie: Studies on the influence of hemodialysis on intracranial pressures. Proc. Int. Symposium on the clinical and metabolic aspects of laevulose. London 1963.

  11. Kennedy, A. C., A. L. Linton, R. G. Luke, S. Renfrew, andA. Dinwoodie: The pathogenesis and prevention of cerebral dysfunction during dialysis. Lancet1964I, 790.

    Google Scholar 

  12. Kolff, W. J.: The artifical kidney-past, present and future. Circulation15, 285 (1957).

    Google Scholar 

  13. Merrill, J. P.: Treatment of acute renal failure by the artifical kidney. Proc. 1st int. Congr. Nephrol. Genève/Evian 1961.

  14. Scheitlin, W., u.A. Hunziger: Die Beeinflussung des Liquor-Chemismus durch Hämodialyse beim urämischen Patienten. Schweiz. med. Wschr.92, 673 (1962).

    Google Scholar 

  15. Schoolar, J. C., C. F. Barlow, andL. J. Roth: The penetration of carbon-14 urea into cerebrospinal fluid and various areas of the cat brain. J. Neuropath. exp. Neurol.19, 216 (1960).

    Google Scholar 

  16. Sitprija, V., andJ. H. Holmes: Preliminary observations on the change in intracranial pressure and intraocular pressure during hemodialysis. Trans. Amer. Soc. Artif. Int. Organs8, 300 (1962).

    Google Scholar 

  17. Shenking, H. A., B. Goluboff, andH. Haft: The use of mannitol for the reduction of intracranial pressure in intracranial surgery. J. Neurosurg.19, 897 (1962).

    Google Scholar 

  18. Wise, B. L., andN. Carter: The value of hypertonic mannitol solution in decreasing brain mass and lowering cerebrospinal-fluid pressure. J. Neurosurg.19, 1038 (1962).

    Google Scholar 

  19. Wise, B. L., andN. Carter: Use of hypertonic mannitol solutions to lower cerebrospinal fluid pressure and decrease brain bulk in man. Surg. Forum12, 398 (1961).

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Aus der I. Medizinischen Klinik der Universität München, Germany

    H. H. Edel, H. J. Gurland, E. Renner, J. Eigler & E. Buchborn

Authors
  1. H. H. Edel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. J. Gurland
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Renner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Eigler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Buchborn
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Mit Unterstützung der Deutschen Forschungsgemeinschaft. — Technische Assistenz: Frl.C. Henschel, Frl.M. Weber und Frl.I. Schröder.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Edel, H.H., Gurland, H.J., Renner, E. et al. Das Verhalten der Blut-Liquorgradienten bei Azotämie und ihre Beeinflussung durch die Hämodialyse. Klin Wochenschr 43, 1081–1086 (1965). https://doi.org/10.1007/BF01734182

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01734182

Search

Navigation