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Nierenersatztherapie als mögliches Trauma im akuten Nierenversagen

Renal replacement therapy as a possible trauma in acute kidney injury

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Zusammenfassung

Hintergrund

Eine sog. Nierenersatztherapie kann die physiologischen Funktionen der gesunden Niere nur unvollständig ersetzen. Dabei kann jede Nierenersatztherapie zusätzlich mit einer Reihe von relevanten Nebenwirkungen und Komplikationen verbunden sein, die bei kritisch kranken Patienten den Verlauf und die Prognose erheblich beeinflussen können.

Problemstellung

Neben den hämodynamischen Auswirkungen beinhaltet das sog. Nierenersatztrauma v. a. die Induktion von Entzündung durch den extrakorporalen Kreislauf, die Folgen der Antikoagulation sowie insbesondere den meist unerwünschten und oft unerkannten Verlust einer Vielzahl von Substanzen durch das Blutreinigungsverfahren selbst.

Zielsetzung

Ziel muss es daher sein, die Therapie so zu gestalten, dass systemische aber auch renale Nebenwirkungen möglichst gering bleiben oder ausgeglichen werden. Dazu gehört die richtige Verfahrenswahl für jeden individuellen Patienten in der individuellen klinischen Situation, die Festlegung einer individuellen Therapiedosis und die Substitution von unerwünschten Verlusten. Besonderes bei septischen Patienten sollte auf eine adäquate Dosis von Antiinfektiva geachtet werden. In den ersten 72 h besteht hier sonst die Gefahr einer Unterdosierung dieser Substanzen bei laufendem Nierenersatzverfahren.

Abstract

Background

Renal replacement therapy (RRT) is not able to replace all of the physiologic functions of the kidney. Moreover renal replacement therapy can be associated with a number of serious side effects and complications which can alter the natural course and prognosis of critically ill patients.

Problem

Contributing to this RRT trauma are hemodynamic changes induced by RRT, the induction of inflammation by the extracorporeal circuit itself, side effects of anticoagulation, but especially often unwanted and not recognized losses of multiple substances by the blood purification itself.

Aim

Therefore, the aim should be to adapt therapy in a way that systemic and renal side effects can be minimized or replaced. These include the correct selection of the RRT modality for each patient and each individual clinical situation, in prescribing and monitoring an individual dose of RRT, and the substitution of unwanted losses of different substances. Especially in septic patients, antimicrobials have to be prescribed carefully during the first 72 h, during which underdosing of these substances is a real danger in patients on renal replacement therapy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. John gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Medizinische Klinik 4, Universität Erlangen-Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland

    S. John

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John, S. Nierenersatztherapie als mögliches Trauma im akuten Nierenversagen. Med Klin Intensivmed Notfmed 109, 342–347 (2014). https://doi.org/10.1007/s00063-013-0338-8

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  • DOI: https://doi.org/10.1007/s00063-013-0338-8

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