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2015 | OriginalPaper | Buchkapitel

1. Akute Nierenschädigung – Status Quo

verfasst von: Michael Haase, Anja Haase-Fielitz

Erschienen in: Akute Nierenschädigung

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Die akute Nierenschädigung kann auch bei scheinbar vollständiger Nierenfunktionserholung ursächlich für die Entwicklung einer chronischen Niereninsuffizienz sein und trägt zu einer Auslösung bzw. Verschlimmerung nicht-renaler Organschäden bei.
Es herrscht Einigkeit darüber, dass der Anstieg des Serumkreatinins und eine rückläufige Diurese sehr aussagekräftige Marker für die Charakterisierung eines akuten Rückgangs der glomerulären Filtrationsrate sind, weshalb auch neuere Empfehlungen für die Diagnosekriterien der akuten Nierenschädigung diese Nierenfunktionsparameter weiterhin uneingeschränkt berücksichtigen. Jedoch weisen Kreatinin und Diurese als funktionelle Marker inhärente Limitationen auf, d. h. sie können die akute renale Schädigung oft nicht frühzeitig und nicht vollumfänglich abbilden. Marker des akuten Tubulusschadens geben direkte Informationen über den tubulären Status, dies oftmals erheblich vor einem Anstieg der klassischen Nierenfunktionsparameter. Eine Aussage bezüglich der Reversibilität des akuten Nierenfunktionsverlusts kann mithilfe solcher Marker erleichtert werden.
Fachspezifische Empfehlungen zielen auf eine individualisierte Ursachensuche sowie frühzeitige und multimodale Behandlung der akuten Nierenschädigung ab und umfassen das Vermeiden von Nephronoxen bzw. den Ausschluss oder die Behandlung eines Harnstaus, einer Sepsis und der Komplikationen einer akuten Nierenschädigung.
Aufgrund vielfältiger Umstände, wie des initial zumeist asymptomatischen Krankheitsgeschehens und eines erwarteten zumeist vollständig spontan reversiblen Verlaufs vollständig reversiblen Verlaufs, ist eine verzögerte und unvollständige Behandlung der akuten Nierenschädigung eher die Regel als die Ausnahme. Eine Verbesserung der Prognose betroffener Patienten könnte sich durch optimierte Behandlungspfade, z. B. mittels eines EDV-gestützten Frühwarnsystems, erreichen lassen.
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Metadaten
Titel
Akute Nierenschädigung – Status Quo
verfasst von
Michael Haase
Anja Haase-Fielitz
Copyright-Jahr
2015
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-642-45080-8_1

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