Zusammenfassung
Das akute Nierenversagen (ANV) tritt, nach der aktuell entwickelten Definition, mit einer Inzidenz von bis zu 30% nach kardiochirurgischen Eingriffen auf, bei etwa 1% der Betroffenen als dialysepflichtiges Nierenversagen, weshalb der Begriff „cardiac surgery associated acute kidney injury“ (CSA AKI) geprägt wurde. Die ANV-assoziierte Mortalität liegt zwischen 15 und 30% und CSA AKI erhöht die Mortalität, unabhängig von der Komorbidität. Lediglich bei 50% der Überlebenden kommt es zur vollkommenen Regeneration der Nierenfunktion. Die Pathophysiologie des CSA AKI ist keineswegs auf den Einsatz der extrakorporalen Zirkulation begrenzt, sondern ausgesprochen komplex und multifaktoriell und beinhaltet v. a. endogene und exogene Nephrotoxine, Inflammation, Hypoperfusion sowie metabolische und neurohormonale Faktoren. Es existiert keine kausale Therapie des CSA AKI; extrakorporale Nierenersatzverfahren stellen lediglich eine supportive Therapie des ANV dar, um die Zeit bis zur renalen Regeneration zu überbrücken. Daher kommt der primären und sekundären Prävention des ANV mit Korrektur aller vermeidbaren und modifizierbaren Risikofaktoren die entscheidende Rolle zu.
Abstract
Acute kidney injury (AKI) occurs, according to current definitions, in up to 30% of all patients undergoing cardiac surgery. AKI that requires renal replacement therapy has an incidence of approximately 1%. The development of AKI increases mortality to 15–30%, independently of other comorbidities. Full recovery of renal function is only observed in 50% of surviving patients. Thus, due to its significance, the term cardiac surgery-associated acute kidney injury (CSA AKI) was coined. The underlying mechanisms leading to CSA AKI are not limited to the use of cardiopulmonary bypass. In fact, predominant causes include endogenous and exogenous nephrotoxins, inflammation, hypoperfusion, and metabolic and neurohormonal disturbances. Since no causal therapy is available for CSA AKI, primary and secondary prevention is critical to correct all avoidable and modifiable risk factors of AKI. Renal replacement therapy is only supportive to bridge the gap until the kidneys recover.
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Pilarczyk, K., Marggraf, G., Jakob, H. et al. Akutes Nierenversagen nach kardiochirurgischen Eingriffen. Z Herz- Thorax- Gefäßchir 26, 173–180 (2012). https://doi.org/10.1007/s00398-012-0927-5
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DOI: https://doi.org/10.1007/s00398-012-0927-5