Skip to main content
SpringerLink
Log in

Akutes Nierenversagen

Acute renal failure

  • Schwerpunkt: Onkologische Notfälle
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Das akute Nierenversagen geht mit einer plötzlichen und schnell einsetzenden Verschlechterung der Nierenfunktion einher. Zusätzlich zu den üblichen prärenalen, intrinsischen und postrenalen Ursachen sind bei onkologischen Patienten einige Besonderheiten zu beachten. Krankheitsimmanente Faktoren (z. B. paraneoplastische Syndrome oder retroperitoneale Tumormassen) können—noch vor Einleitung einer antineoplastischen Therapie—ein akutes Nierenversagen hervorrufen. Paraproteine, wie sie beim multiplen Myelom gebildet werden, sind weitere mögliche Ursachen einer Nierendysfunktion. Bei einigen zytostatischen Substanzen ist die akute Nephrotoxizität eine häufige, gefürchtete Nebenwirkung. Ein akutes Nierenversagen ist v. a. beim Einsatz von Cisplatin, Methotrexat, Ifosfamid und Melphalan möglich. Mitomycin oder Gemcitabin können ein hämolytisch-urämisches Syndrom verursachen. Eine Rhabdomyolyse mit Myoglobinurie kann nach großen operativen Eingriffen zu einem akuten Nierenversagen führen. Die Therapie von chemosensitiven Neoplasien mit effektiven Zytostatika ruft häufig das Bild eines Tumorlysesyndroms hervor, welches mit Hyperurikämie, Hyperkaliämie, Hyperphosphatämie und Hypokalzämie einhergeht.

Abstract

The acute renal failure is characterized by a rapid detoriation of the renal function. In addition to the usual prerenal, intrinsic and postrenal causes of an acute renal failure distinct causes have to be considered for oncological patients. Factors immanent to the malignant disease, e. g. paraneoplastic syndromes or retroperitoneal bulks can account for an acute renal failure. Paraproteins as produced by a multiple myeloma are other possible causes for renal dysfunction. For some anticancer drugs nephrotoxicity is a potential side effect, in particular for cisplatin, methotrexate, ifosfamide and melphalan. A hemolytic uremic syndrome may be induced by mitomycin and gemcitabine. Extensive surgery can be associated with rhabdomyolysis and myoglobinuria and results in renal impairment. Treatment of a chemosensitive neoplasia with a highly effective regimen may result in a tumor lysis syndrome with hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia.

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

Abb. 1

Literatur

  1. Arany I, Safirstein RL (2003) Cisplatin nephrotoxicity. Semin Nephrol 23: 460–464

    Article  CAS  PubMed  Google Scholar 

  2. Berg H van den, Reintsema AM (2004) Renal tubular damage in rasburicase: risks of alkalinisation. Ann Oncol 15: 175–176

    Article  Google Scholar 

  3. Bishop MR, Coccia PF (2000) Tumor lysis syndrome. In: Abeloff MD et al. (ed) Clinical oncology. Churchill Livingstone, New York, pp 750–754

  4. Cairo MS, Bishop P (2004) Tumor lysis syndrome: new therapeutic strategies and classification. Br J Haematol 127: 3–11

    Article  PubMed  Google Scholar 

  5. Davidson MB, Thakkar S, Hix JK et al. (2004) Pathophysiology, clinical consequences, and treatment of tumor lysis syndrome. Am J Med 116: 546–554

    Article  CAS  PubMed  Google Scholar 

  6. Fadia A, Casserly LF, Sanchorawala V et al. (2003) Incidence and outcome of acute renal failure complicating autologous stem cell transplantation for AL amyloidosis. Kidney Int 63: 1868–1673

    PubMed  Google Scholar 

  7. Goldmann SC, Holcenberg JS, Finklestein JZ et al. (2001) A randomized comparison between rasburicase and allopurinol in children with lymphoma or leukaemia at high risk for tumor lysis. Blood 97: 2998–3003

    Article  PubMed  Google Scholar 

  8. Jakob A, Kanz L, Bokemeyer C (1999) Metabolische Störungen als Notfall bei onkologischen Erkrankungen. Onkologie 5: 1066–1074

    Google Scholar 

  9. Jones DP, Mahmoud H, Chensey RW (1995) Tumor lysis syndrome: pathogenesis and management. Pediatr Nephrol 9: 206–212

    CAS  PubMed  Google Scholar 

  10. Jörres A, Frei U (2001) Akutes Nierenversagen. Internist 42: 379–403

    Article  PubMed  Google Scholar 

  11. Kaplan AA (2001) Therapeutic apheresis for the renal complications of multiple myeloma an the dysglobulinaemias. Ther Apher 5: 165–172

    Google Scholar 

  12. Kapoor M, Chan GZ (2001) Malignancy and renal disease. Crit Care Clin 17: 571–598

    CAS  PubMed  Google Scholar 

  13. Kedar A, Grow W, Neiberger RE (1995) Clinical versus laboratory tumor lysis syndrome in children with acute leukaemia. Pediatr Haematol Oncol 12: 129–134

    CAS  Google Scholar 

  14. Kerbusch T, de Kraker J, Keizer HJ et al. (2001) Clinical pharmacokinetics and pharmacodynamics of ifosfamide and its metabolites. Clin Pharmacokinet 40: 41–62

    CAS  Google Scholar 

  15. Kern W, Braess J, Kaufmann CC, Wilde S, Schleyer E, Hiddemann W (2000) Microalbuminuria during cisplatin therapy: relation with pharmacokinetics and implications for nephroprotection. Anticancer Res 20: 3679–3688

    CAS  PubMed  Google Scholar 

  16. Kintzel PE (2001) Anticancer drug-induced kidney disorders. Drug Safety 24: 19–38

    CAS  PubMed  Google Scholar 

  17. Kintzel PE, Dorr RT (1995) Anticancer drug renal toxicity and elimination: dosing guidelines for altered renal function. Cancer Treat Rev 21: 33–64

    Article  CAS  PubMed  Google Scholar 

  18. Krych M, Dreyling M, Kneba M, Hoelzer D, Hiddemann W, Hallek MD (2004) Prophylaxe und differentielle Therapie des Tumorlysesyndroms. Dtsch Med Wochenschr 129: 1440–1445

    Article  CAS  PubMed  Google Scholar 

  19. Lee CK, Zangari M, Barlogie B et al. (2004) Dialysis-dependent renal failure in patients with myeloma can be reversed by high-dose myeloablative therapy and autotransplant. Bone Marrow Transplant 33: 823–828

    Article  CAS  PubMed  Google Scholar 

  20. Mistry B, Kimmel PL, Hetzel PC, Phillips TM, Braden GL (2004) The role of circulating immune complexes and biocompatibility of staphylococcal protein A immunoadsorption in mitomycin C-induced hemolytic uremic syndrome. Am J Kidney Dis 44: e50–58

    PubMed  Google Scholar 

  21. Möckel M, Bahr F, Leuner Ch, Kuhn H, Dietz R (2002) Empfehlungen zur Prophylaxe der durch Röntgen-Kontrastmittel (RKM) induzierten Nephropathie. Z Kardiol 91: 719–726

    Article  PubMed  Google Scholar 

  22. Muller S, Schutt P, Bojko P et al. (2004) Hemolytic uremic syndrome following prolonged gemcitabine therapy: report of four cases from a single institution. Ann Hematol [Epub ahead of print]

    Google Scholar 

  23. Orihuela E, Nazemi T, Shu T (2001) Acute renal failure due to rhabdomyolysis associated with radical perineal prostatectomy. Eur Urol 39: 606–609

    Article  CAS  PubMed  Google Scholar 

  24. O’Quigley J, Chevret S (1991) Methods for dose finding studies in cancer clinical trials: a review and results of a Monte Carlo study. Stat Med 10: 1647–1664

    PubMed  Google Scholar 

  25. Polycarpe E, Arnould L, Schmitt E et al. (2004) Low urine osmolarity as a determinant of cisplatin-induced nephrotoxicity. Int J Cancer 111: 131–137

    Article  CAS  PubMed  Google Scholar 

  26. Shen DD, Azarnoff DL (1978) Clinical pharmacokinetics of methotrexate. Clin Pharmacokin 8: 1–18

    Google Scholar 

  27. Slater MS, Mullins RJ (1998) Rhabdomyolysis and myoglobinuric renal failure in trauma and surgical patients. J Am Coll Surg 186: 693–716

    Article  CAS  PubMed  Google Scholar 

  28. Smalley RV, Guaspari A, Haase-Statz S et al. (2000) Allopurinol: Intravenous use for prevention and treatment of hyperuricaemia. J Clin Oncol 18: 1758–1763

    CAS  PubMed  Google Scholar 

  29. Ten Harkel ADJ, Kist-Van Holte JE, Van Well M et al. (1998) Alkalinization and the tumor lysis syndrome. Medical Pediatr Oncol 31: 27–28

    Article  Google Scholar 

  30. Wechsler DS, Kastan MB, Fivush BA (1994) Resolution of nephrocalcinosis associated with tumor lysis syndrome. Pediatr Haematol Oncol 11: 115–118

    CAS  Google Scholar 

  31. Zager RA (1996) Rhabdomyolysis and myohemoglobinuric acute renal failure. Kidney Int 49: 314–326

    CAS  PubMed  Google Scholar 

  32. Zucchelli P, Pasquali S, Cagnoli L et al. (1988) Controlled plasma exchange trial in acute renal failure due to multiple myeloma. Kidney Int 33: 1175–1189

    CAS  PubMed  Google Scholar 

  33. Zippel RM (2002) Tumorlysesyndrom, tubuläre Obstruktion, Cisplatin. Nieren Hochdruckkrankh 31: 484–488

    Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Medizinische Klinik und Poliklinik III, Klinikum Großhadern, Universität München

    M. Krych

  2. Medizinische Klinik und Poliklinik III, Klinikum Großhadern, Marchioninistraße 15, 81377, München

    M. Krych

Authors
  1. M. Krych
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Krych.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Krych, M. Akutes Nierenversagen. Internist 46, 30–38 (2005). https://doi.org/10.1007/s00108-004-1316-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-004-1316-2

Schlüsselwörter

Keywords

Search

Navigation