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Heilung oder Progress – die AKI‑CKD‑Transition

Recovery or progression—AKI‑CKD transition

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Die Nephrologie Aims and scope

Zusammenfassung

Die akute Nierenschädigung („acute kidney injury“, AKI) ist einer der häufigsten Gründe einer Nierenfunktionsverschlechterung, insbesondere bei Patienten und Patientinnen im Krankenhaus. Die meisten Fälle eines AKI zeigen im Verlauf eine gewisse Erholung der Nierenfunktion, allerdings ist ein AKI ein wichtiger Risikofaktor für die Entwicklung und Progression einer chronischen Nierenkrankheit („chronic kidney disease“, CKD). Eine CKD wiederum ist ein wichtiger Risikofaktor für die Entwicklung eines AKI und einer ausbleibenden Erholung nach AKI. Beide Zustände zeigen pathophysiologische Ähnlichkeiten, wie Verlust von Nephronen, Fibrosierung, Rarefizierung der kleinen Blutgefäße und Einwanderung von Entzündungszellen, was die epidemiologische Assoziation bedingen könnte. Sowohl AKI als auch CKD sind zudem mit einer erhöhten Mortalität assoziiert, was unter anderem durch die wechselseitige negative Beeinflussung mit anderen Organsystemen (sog. Organ-Crosstalk) erklärt werden kann. Sowohl AKI als auch ein Zustand nach AKI sollten ernst genommen werden und die Patienten und Patientinnen eine AKI-Nachsorge erhalten. Hier sollten nicht nur eine Kontrolle und ggf. Behandlung einer eingeschränkten Nierenfunktion, sondern auch mögliche Folgen an anderen Organen wie dem kardiovaskulären System bedacht werden.

Abstract

Acute kidney injury (AKI) is one of the most frequent causes of kidney function deterioration, especially in hospitalized patients. Most cases of AKI show a certain amount of recovery of kidney function over time but AKI is an important risk factor for the development and progression of chronic kidney disease (CKD). In turn, CKD is an important risk factor for the development of AKI and failure to recover after AKI. Both conditions show pathophysiological similarities, such as loss of nephrons, fibrosis, small blood vessel rarefaction and inflammatory cell infiltration, which could account for the epidemiological association. Both AKI and CKD are also associated with increased mortality, which can be explained, among other things, by the reciprocal negative influence with other organ systems, so-called organ crosstalk. Both AKI and a history of past AKI should be taken seriously and patients should receive AKI follow-up care. This should not only include monitoring and, if necessary, treatment of impaired kidney function but also possible consequences for other organs such as the cardiovascular system.

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Authors and Affiliations

  1. Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    Philipp Enghard, Ricarda Hinz & Kai-Uwe Eckardt

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  1. Philipp Enghard
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  3. Kai-Uwe Eckardt
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Correspondence to Philipp Enghard.

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P. Enghard, R. Hinz und K.-U. Eckardt geben an, dass kein Interessenkonflikt besteht.

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Kai-Uwe Eckardt, Berlin

Kirsten de Groot, Offenbach am Main

Kai Schmidt-Ott, Hannover

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Enghard, P., Hinz, R. & Eckardt, KU. Heilung oder Progress – die AKI‑CKD‑Transition. Nephrologie (2024). https://doi.org/10.1007/s11560-024-00725-2

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