Summary
Adjuvant therapeutic strategies in patients with acute renal failure are part of high quality intensive care management. They have to include preventive as well as therapeutic aspects, especially careful hemodynamic monitoring and optimization of the often deranged fluid balance. Nephrotoxic substances (e. g., radiocontrast agents, aminoglycosides, nonsteroidal antiinflammatory drugs) should be avoided or at least scrutinized.
The vaspressor of choice is epinephrine. High-dose loop diuretics should be used cautiously in critically ill patients with acute renal failure. The medical standard also comprises adequate nutrition and subsequent correction of an elevated blood glucose level. It is a challenge to recognize complications early, to prevent or to treat them adequately. Sick and complex hospitalized patients offer ample opportunity for a collaborative interaction between the intensivist and the nephrologist in an intensive care unit.
Zusammenfassung
Adjuvante Therapieverfahren bei Patienten im akuten Nierenversagen stellen eine hochqualifizierte Intensivbehandlung dar. Sie sollten präventive und therapeutische Aspekte unter sorgfältiger Beachtung der Hämodynamik und der Optimierung der Flüssigkeitsbilanz berücksichtigen. Der Einsatz von Nephrotoxinen wie z. B. Röntgenkontrastmittel, Aminoglykosiden, nichtsteroidalen Antiphlogistika sollte kritisch hinterfragt und sofern möglich gemieden werden.
Vasopressor der ersten Wahl ist Noradrenalin. Der Einsatz von Schleifendiuretika sollte bedacht und vorsichtig erfolgen. Adäquate Ernährung und konsequente Blutzuckereinstellung sind heute absoluter medizinischer Standard. Unsere Sorgfalt muss auf Erkennung und Behandlung von Komplikationen zielen. Hierfür ist ein interdisziplinärer Ansatz besonders gut geeignet.
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Hornberger, M. Stellenwert adjuvanter Therapien des akuten Nierenversagens. Clin Res Cardiol Suppl 2 (Suppl 1), S108–S114 (2007). https://doi.org/10.1007/s11789-006-0045-6
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DOI: https://doi.org/10.1007/s11789-006-0045-6
Key words
- Acute renal failure
- therapeutic strategies
- intensive care unit
- diuretics
- vasopressor therapy
- volume expansion
- malnutrition
- intensive insulin therapy
- nephrologist