Zusammenfassung
Das kardiorenale Syndrom beschreibt die klinische Situation eines akuten Nierenversagens bei einem akut kardial dekompensierten Patienten im Verlauf der Herzinsuffizienztherapie. Ursache ist eine rasche Verschlechterung der beim Großteil akut herzinsuffizienter Patienten bereits bestehenden chronischen Niereninsuffizienz. Bei dieser Konstellation muss eine diuretische Therapie besonders vorsichtig und langsam durchgeführt werden, um einen inadäquaten Volumenentzug zu vermeiden. Mitunter kann dies nur unter intensivmedizinischer Überwachung geschehen. Nierenersatzverfahren können beim kardiorenalen Syndrom vorteilhaft sein, da sie bei Therapiebeginn einen schnelleren Flüssigkeitsentzug und im Verlauf eine bessere Kontrolle des Volumenentzugs ermöglichen. Die individuelle Behandlung der Patienten mit kardiorenalem Syndrom bedarf der kooperativen Abstimmung zwischen Kardiologen und Nephrologen.
Abstract
The cardiorenal syndrome describes the frequent clinical situation in which therapy of a patient with acute cardiac decompensation is limited by a decline of renal function. This is frequently associated with preexisting chronic renal insufficiency. It is important to be aware of this potentially fatal constellation and perform diuretic therapy slowly and carefully in order to avoid inadequate volume depletion. This may require surveillance in an intensive care unit. Ultrafiltration is an alternative to diuretic therapy which may permit greater fluid loss when beginning therapy and better control of volume reduction once heart failure symptoms improve. The individual treatment of patients with cardiorenal syndrome requires a close cooperation between cardiologists and nephrologists.
Abbreviations
- ACE:
-
Angiotensin-Converting-Enzym
- CAPD:
-
Continuous Ambulatory Peritoneal Dialysis
- GFR:
-
Glomeruläre Filtrationsrate
- KHK:
-
Koronare Herzkrankheit
- LDL:
-
Low Density Lipoprotein
- NYHA:
-
New York Heart Association
- PD:
-
Peritonealdialyse
Literatur
Alscher MD (2009) Herz und Niere – von der Risikostratifikation bis zu Wechselwirkungen der medikamentösen Therapie. Kardiologe 3:489–498
Baigent C, Landray MJ, Reith C et al (2011) The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 377:2181–2192
Coresh J, Selvin E, Stevens LA et al (2007) Prevalence of chronic kidney disease in the United States. JAMA 298:2038–2047
Costanzo MR, Guglin ME, Saltzberg MT et al (2007) Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 49:675–683
Di Angelantonio E, Chowdhury R, Sarwar N et al (2010) Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: prospective population based cohort study. BMJ 341:c4986
European Association for Cardiovascular Prevention & Rehabilitation, Reiner Z, Catapano AL, De Backer G et al (2011) ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 32:1769–1818
Hage FG, Venkataraman R, Zoghbi GJ et al (2009) The scope of coronary heart disease in patients with chronic kidney disease. J Am Coll Cardiol 53:2129–2140
Jessup M, Costanzo MR (2009) The cardiorenal syndrome: do we need a change of strategy or a change of tactics? J Am Coll Cardiol 53:597–599
Lameire N, Van Biesen W (2010) Epidemiology of peritoneal dialysis: a story of believers and nonbelievers. Nat Rev Nephrol 6:75–82
Mehrotra R, Kathuria P (2006) Place of peritoneal dialysis in the management of treatment-resistant congestive heart failure. Kidney Int Suppl (103):67–71
Mehta RL, Kellum JA, Shah SV et al (2007) Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31
Mentz RJ, Lewis EF (2011) Epidemiology of cardiorenal syndrome. Cardiol Clin 29:301–314
Mosterd A, Hoes AW (2007) Clinical epidemiology of heart failure. Heart 93:1137–1146
Mullens W, Abrahams Z, Francis GS et al (2009) Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 53:589–596
Orasanu G, Plutzky J (2009) The pathologic continuum of diabetic vascular disease. J Am Coll Cardiol 53:35–42
Phillips CO, Kashani A, Ko DK et al (2007) Adverse effects of combination angiotensin II receptor blockers plus angiotensin-converting enzyme inhibitors for left ventricular dysfunction: a quantitative review of data from randomized clinical trials. Arch Intern Med 167:1930–1936
Roger VL, Go AS, Lloyd-Jones DM et al (2011) Heart disease and stroke statistics – 2011 update: a report from the American Heart Association. Circulation 123:e18–e209
Ronco C, Haapio M, House AA et al (2008) Cardiorenal syndrome. J Am Coll Cardiol 52:1527–1539
Sanchez JE, Ortega T, Rodriguez C et al (2010) Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure. Nephrol Dial Transplant 25:605–610
Sarnak MJ, Levey AS, Schoolwerth AC et al (2003) Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 108:2154–2169
Shlipak MG (2003) Pharmacotherapy for heart failure in patients with renal insufficiency. Ann Intern Med 138:917–924
Strippoli GF, Navaneethan SD, Johnson DW et al (2008) Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials. BMJ 336:645–651
Tang WH, Mullens W (2010) Cardiorenal syndrome in decompensated heart failure. Heart 96:255–2560
Wanner C, Krane V, Marz W et al (2005) Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 353:238–248
Yusuf S, Teo KK, Pogue J et al (2008) Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 358:1547–1559
Interessenkonflikt
Keine Angabe
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alscher, M., Sechtem, U. Kardiorenales Syndrom. Internist 53, 309–318 (2012). https://doi.org/10.1007/s00108-011-2981-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00108-011-2981-6
Schlüsselwörter
- Kardiorenales Syndrom
- Niereninsuffizienz
- Herzinsuffizienz
- Akutes Nierenversagen
- Kardiovaskuläre Erkrankungen