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Akute Nierenschädigung nach Herzchirurgie

Frühdiagnose mit Neutrophilen-Gelatinase-assoziiertem Lipocalin

Acute kidney injury after cardiac surgery

Early diagnosis with neutrophil gelatinase-associated lipocalin

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Zusammenfassung

In der klinischen Praxis basiert die Diagnose der akuten Nierenschädigung derzeit auf funktionellen Markern, d. h. einem Anstieg der Serumkreatininkonzentration oder einem Diureserückgang. Biomarker für die frühe Erkennung struktureller Nierenschäden waren bislang nicht verfügbar. Diesem Dilemma wird ein erheblicher Anteil an der seit Jahrzehnten ausbleibenden Verbesserung der Überlebenschancen der Betroffenen, und der erschwerten Entwicklung neuer und effektiver Therapien zugeschrieben. Mit der Bestimmung neuer renaler Marker, z. B. Neutrophilen-Gelatinase-assoziiertes Lipocalin (NGAL), kann die Diagnose einer akuten Nierenschädigung auch nach kardiochirurgischen Eingriffen 24 bis 48 Stunden früher als bislang gestellt werden. Neben zeitnah einzuleitenden therapeutischen Maßnahmen sind wertvolle Hinweise bezüglich des perioperativen Managements zu erwarten. Gegenwärtig erschwert das Fehlen eines NGAL-Trennwerts seine klinische Implementierung. Bevor die Leitlinien geändert werden können, sollten multizentrische, randomisierte Studien mit neuen renalen Biomarkern wie NGAL als Einschlusskriterium einen klinischen Nutzen bzw. ein günstiges Kosten-Nutzen-Verhältnis nachweisen.

Abstract

In current clinical practice, the diagnosis of acute kidney injury (AKI) is based on markers of renal function, e.g., an increase in serum creatinine or a decrease in urine output. Biomarkers for the early detection of structural renal damage are still not available. This dilemma may have considerably contributed to the delayed development of effective therapies and poor prognosis for the affected patients. The measurement of novel renal damage biomarkers, such as neutrophil gelatinase-associated lipocalin (NGAL), enables a 24 to 48-hour earlier diagnosis of AKI after cardiac surgical procedures. Based on the presence of a biomarker, potentially effective treatments may be initiated or nephrotoxins withdrawn. In addition, NGAL may also provide valuable information for patient management. Currently, no clear NGAL cut-off has been established, thus, impeding its clinical implementation. Prior to a change of guidelines, multicenter randomized studies, using NGAL as an entry criterion, should prove a benefit for the patients or a favorable cost–benefit ratio.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Der Autor hat Vortragshonorare von Biosite/Inverness und Abbott Diagnostics erhalten. Beide Firmen entwickeln NGAL als Marker zur Frühdiagnose renaler Schäden und waren nicht an der Erstellung oder Revision dieses oder anderer Manuskripte des Autors beteiligt.

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  1. Zentrum für Innere Medizin, Universitätsklinik für Nieren- und Hochdruckkrankheiten, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    M. Haase & A. Haase-Fielitz

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  1. M. Haase
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  2. A. Haase-Fielitz
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Correspondence to M. Haase.

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Haase, M., Haase-Fielitz, A. Akute Nierenschädigung nach Herzchirurgie. Med Klin 106, 111–116 (2011). https://doi.org/10.1007/s00063-011-0050-5

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  • DOI: https://doi.org/10.1007/s00063-011-0050-5

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