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Akute Nierenschädigung und Sepsis

Acute kidney injury and sepsis

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Zusammenfassung

Hintergrund

Die akute Nierendysfunktion (AKI) ist ein wichtiges Organversagen, das die Prognose bei Patienten mit schwerer Sepsis erheblich negativ beeinflusst.

Methodik

In dieser Arbeit werden die pathophysiologischen Ursachen sowie die konservative und extrakorporale Therapie bei Patienten mit schwerer Sepsis und Nierendysfunktion beschrieben.

Ergebnisse

Therapeutisch stehen zunächst die Infektsanierung und hämodynamische Stabilisierung mittels Volumentherapie und Katecholamingabe im Vordergrund. Bei sich abzeichnend anhaltend schlechter Nierenfunktion sollte frühzeitig eine extrakorporale Therapie eingeleitet werden. Grundsätzlich sind sowohl intermittierende als auch kontinuierliche Verfahren geeignet. In der Praxis wird in der (hämodynamisch instabilen) Initialphase ein kontinuierliches Verfahren favorisiert.

Diskussion

Die Vorstellung, dass ein AKI durch Nierenersatztherapie einfach überwunden werden kann, wird der Komplexität der Erkrankung nicht gerecht. Wichtig ist, die Dynamik der Erkrankung hinsichtlich der Dosisfindung und der Modalität des Nierenersatzverfahrens zu beachten. Eine Reduktion von Antibiotikadosierungen gemäß der eingeschränkten Nierenfunktion ist ebenso wichtig wie die Erhöhung der selbigen unter der Nierenersatztherapie.

Abstract

Background

Acute kidney injury (AKI) is an important organ failure, which has an enormous negative impact on outcome in patients with severe sepsis.

Methods

In this paper, the pathophysiological causes as well as noninterventional and interventional (extracorporeal) treatment of patients with AKI and severe sepsis are described.

Results

The cornerstone of noninterventional therapy is infection control and heamodynamic stabilization with fluid resuscitation and vasopressors. In patients with deteriorating AKI, extracorporeal treatment should be started early. Generally, continuous and intermittent modes are considered to be equally effective and possible. In practice, a continuous form is preferred in hemodynamically unstable patients.

Discussion

The idea that AKI may easily be overcome by starting extracorporeal treatment is no longer true. AKI is much more complex. The dynamic process of the disease should be kept in mind when choosing the correct mode and dose of the extracorporeal treatment. Antibiotic dosage must be adjusted when kidney function is improving or deteriorating.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Oppert gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Notfall- und internistische Intensivmedizin, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland

    M. Oppert

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Oppert, M. Akute Nierenschädigung und Sepsis. Med Klin Intensivmed Notfmed 109, 331–335 (2014). https://doi.org/10.1007/s00063-013-0340-1

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  • DOI: https://doi.org/10.1007/s00063-013-0340-1

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