Skip to main content
main-content
Erschienen in: Die Innere Medizin 6/2019

18.04.2019 | Akutes Nierenversagen | Schwerpunkt: Biomarker in der Akutmedizin

Akute Nierenschädigung: von Kreatinin zu KIM‑1?

verfasst von: M. Wallbach, B. Tampe, H. Dihazi, Prof. Dr. med. M. J. Koziolek

Erschienen in: Die Innere Medizin | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Zusammenfassung

In der Diagnostik der akuten Nierenschädigung („acute kidney injury“ [AKI]) sind neben dem frühen Erfassen der AKI mehrere Probleme bzw. Fragen zu adressieren. Dazu zählen das Erkennen der Ursache, der Schwere (funktionell oder strukturell), der Prognose (Erholung oder Übergang in chronisches Nierenversagen) und des Verlaufs (Dialysepflichtigkeit oder nicht) sowie das Erfassen spezifischer Therapiemöglichkeiten bei AKI. Der vorliegende Beitrag gibt einen Überblick über etablierte und neue Biomarker der AKI sowie einen Ausblick auf zukünftige biomarkerassoziierte Modelle der AKI.
Literatur
1.
Zurück zum Zitat Alge JL, Arthur JM (2015) Biomarkers of AKI: a review of mechanistic relevance and potential therapeutic implications. Clin J Am Soc Nephrol 10:147–155 CrossRef Alge JL, Arthur JM (2015) Biomarkers of AKI: a review of mechanistic relevance and potential therapeutic implications. Clin J Am Soc Nephrol 10:147–155 CrossRef
2.
Zurück zum Zitat Amato RJ, Stephenson J, Hotte S et al (2012) MG98, a second-generation DNMT1 inhibitor, in the treatment of advanced renal cell carcinoma. Cancer Invest 30:415–421 CrossRef Amato RJ, Stephenson J, Hotte S et al (2012) MG98, a second-generation DNMT1 inhibitor, in the treatment of advanced renal cell carcinoma. Cancer Invest 30:415–421 CrossRef
3.
Zurück zum Zitat Arthur JM, Hill EG, Alge JL et al (2014) Evaluation of 32 urine biomarkers to predict the progression of acute kidney injury after cardiac surgery. Kidney Int 85:431–438 CrossRef Arthur JM, Hill EG, Alge JL et al (2014) Evaluation of 32 urine biomarkers to predict the progression of acute kidney injury after cardiac surgery. Kidney Int 85:431–438 CrossRef
4.
Zurück zum Zitat Balasubramanian G, Al-Aly Z, Moiz A et al (2011) Early nephrologist involvement in hospital-acquired acute kidney injury: a pilot study. Am J Kidney Dis 57:228–234 CrossRef Balasubramanian G, Al-Aly Z, Moiz A et al (2011) Early nephrologist involvement in hospital-acquired acute kidney injury: a pilot study. Am J Kidney Dis 57:228–234 CrossRef
5.
Zurück zum Zitat Bechtel W, McGoohan S, Zeisberg EM et al (2010) Methylation determines fibroblast activation and fibrogenesis in the kidney. Nat Med 16:544–U575 CrossRef Bechtel W, McGoohan S, Zeisberg EM et al (2010) Methylation determines fibroblast activation and fibrogenesis in the kidney. Nat Med 16:544–U575 CrossRef
6.
Zurück zum Zitat Bonventre JV, Vaidya VS, Schmouder R et al (2010) Next-generation biomarkers for detecting kidney toxicity. Nat Biotechnol 28:436–440 CrossRef Bonventre JV, Vaidya VS, Schmouder R et al (2010) Next-generation biomarkers for detecting kidney toxicity. Nat Biotechnol 28:436–440 CrossRef
7.
Zurück zum Zitat Chang YT, Yang CC, Pan SY et al (2016) DNA methyltransferase inhibition restores erythropoietin production in fibrotic murine kidneys. J Clin Investig 126:721–731 CrossRef Chang YT, Yang CC, Pan SY et al (2016) DNA methyltransferase inhibition restores erythropoietin production in fibrotic murine kidneys. J Clin Investig 126:721–731 CrossRef
8.
Zurück zum Zitat Delanaye P, Cavalier E, Morel J et al (2014) Detection of decreased glomerular filtration rate in intensive care units: serum cystatin C versus serum creatinine. BMC Nephrol 15:9 CrossRef Delanaye P, Cavalier E, Morel J et al (2014) Detection of decreased glomerular filtration rate in intensive care units: serum cystatin C versus serum creatinine. BMC Nephrol 15:9 CrossRef
9.
Zurück zum Zitat Devarajan P, Krawczeski CD, Nguyen MT et al (2010) Proteomic identification of early biomarkers of acute kidney injury after cardiac surgery in children. Am J Kidney Dis 56:632–642 CrossRef Devarajan P, Krawczeski CD, Nguyen MT et al (2010) Proteomic identification of early biomarkers of acute kidney injury after cardiac surgery in children. Am J Kidney Dis 56:632–642 CrossRef
10.
Zurück zum Zitat Dihazi H, Koziolek MJ, Datta RR et al (2016) FABP1 and FABP3 have high predictive values for renal replacement therapy in patients with acute kidney injury. Blood Purif 42:202–213 CrossRef Dihazi H, Koziolek MJ, Datta RR et al (2016) FABP1 and FABP3 have high predictive values for renal replacement therapy in patients with acute kidney injury. Blood Purif 42:202–213 CrossRef
11.
Zurück zum Zitat Doi K, Negishi K, Ishizu T et al (2011) Evaluation of new acute kidney injury biomarkers in a mixed intensive care unit. Crit Care Med 39:2464–2469 CrossRef Doi K, Negishi K, Ishizu T et al (2011) Evaluation of new acute kidney injury biomarkers in a mixed intensive care unit. Crit Care Med 39:2464–2469 CrossRef
12.
Zurück zum Zitat Ehret GB, Munroe PB, Rice KM et al (2011) Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk. Nature 478:103–109 CrossRef Ehret GB, Munroe PB, Rice KM et al (2011) Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk. Nature 478:103–109 CrossRef
13.
Zurück zum Zitat Gocze I, Jauch D, Gotz M et al (2018) Biomarker-guided intervention to prevent acute kidney injury after major surgery the prospective randomized BigpAK study. Ann Surg 267:1013–1020 CrossRef Gocze I, Jauch D, Gotz M et al (2018) Biomarker-guided intervention to prevent acute kidney injury after major surgery the prospective randomized BigpAK study. Ann Surg 267:1013–1020 CrossRef
14.
Zurück zum Zitat Gonzalez F, Vincent F (2012) Biomarkers for acute kidney injury in critically ill patients. Minerva Anestesiol 78:1394–1403 PubMed Gonzalez F, Vincent F (2012) Biomarkers for acute kidney injury in critically ill patients. Minerva Anestesiol 78:1394–1403 PubMed
15.
Zurück zum Zitat Gorski M, Tin A, Garnaas M et al (2015) Genome-wide association study of kidney function decline in individuals of European descent. Kidney Int 87:1017–1029 CrossRef Gorski M, Tin A, Garnaas M et al (2015) Genome-wide association study of kidney function decline in individuals of European descent. Kidney Int 87:1017–1029 CrossRef
16.
Zurück zum Zitat Guo C, Dong G, Liang X et al (2019) Epigenetic regulation in AKI and kidney repair: mechanisms and therapeutic implications. Nat Rev Nephrol 15(4):220–239 CrossRef Guo C, Dong G, Liang X et al (2019) Epigenetic regulation in AKI and kidney repair: mechanisms and therapeutic implications. Nat Rev Nephrol 15(4):220–239 CrossRef
17.
Zurück zum Zitat Haase M, Devarajan P, Haase-Fielitz A et al (2011) The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury A multicenter pooled analysis of prospective studies. J Am Coll Cardiol 57:1752–1761 CrossRef Haase M, Devarajan P, Haase-Fielitz A et al (2011) The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury A multicenter pooled analysis of prospective studies. J Am Coll Cardiol 57:1752–1761 CrossRef
18.
Zurück zum Zitat Han WK, Bailly V, Abichandani R et al (2002) Kidney Injury Molecule-1 (KIM-1): a novel biomarker for human renal proximal tubule injury. Kidney Int 62:237–244 CrossRef Han WK, Bailly V, Abichandani R et al (2002) Kidney Injury Molecule-1 (KIM-1): a novel biomarker for human renal proximal tubule injury. Kidney Int 62:237–244 CrossRef
19.
Zurück zum Zitat Hanna MH, Segar JL, Teesch LM et al (2013) Urinary metabolomic markers of aminoglycoside nephrotoxicity in newborn rats. Pediatr Res 73:585–591 CrossRef Hanna MH, Segar JL, Teesch LM et al (2013) Urinary metabolomic markers of aminoglycoside nephrotoxicity in newborn rats. Pediatr Res 73:585–591 CrossRef
20.
Zurück zum Zitat Herget-Rosenthal S, Marggraf G, Husing J et al (2004) Early detection of acute renal failure by serum cystatin C. Kidney Int 66:1115–1122 CrossRef Herget-Rosenthal S, Marggraf G, Husing J et al (2004) Early detection of acute renal failure by serum cystatin C. Kidney Int 66:1115–1122 CrossRef
21.
Zurück zum Zitat Herget-Rosenthal S, Pietruck F, Volbracht L et al (2005) Serum cystatin C—a superior marker of rapidly reduced glomerular filtration after uninephrectomy in kidney donors compared to creatinine. Clin Nephrol 64:41–46 CrossRef Herget-Rosenthal S, Pietruck F, Volbracht L et al (2005) Serum cystatin C—a superior marker of rapidly reduced glomerular filtration after uninephrectomy in kidney donors compared to creatinine. Clin Nephrol 64:41–46 CrossRef
22.
Zurück zum Zitat Hocher B, Adamski J (2017) Metabolomics for clinical use and research in chronic kidney disease. Nat Rev Nephrol 13:269–284 CrossRef Hocher B, Adamski J (2017) Metabolomics for clinical use and research in chronic kidney disease. Nat Rev Nephrol 13:269–284 CrossRef
24.
Zurück zum Zitat Huang N, Tan L, Xue ZG et al (2012) Reduction of DNA hydroxymethylation in the mouse kidney insulted by ischemia reperfusion. Biochem Biophys Res Commun 422:697–702 CrossRef Huang N, Tan L, Xue ZG et al (2012) Reduction of DNA hydroxymethylation in the mouse kidney insulted by ischemia reperfusion. Biochem Biophys Res Commun 422:697–702 CrossRef
25.
Zurück zum Zitat Jo SK, Rosner MH, Okusa MD (2007) Pharmacologic treatment of acute kidney injury: why drugs haven’t worked and what is on the horizon. Clin J Am Soc Nephrol 2:356–365 CrossRef Jo SK, Rosner MH, Okusa MD (2007) Pharmacologic treatment of acute kidney injury: why drugs haven’t worked and what is on the horizon. Clin J Am Soc Nephrol 2:356–365 CrossRef
26.
Zurück zum Zitat Jones TF, Bekele S, O’Dwyer MJ et al (2018) MicroRNas in acute kidney injury. Nephron 140:124–128 CrossRef Jones TF, Bekele S, O’Dwyer MJ et al (2018) MicroRNas in acute kidney injury. Nephron 140:124–128 CrossRef
28.
Zurück zum Zitat Klein SJ, Brandtner AK, Lehner GF et al (2018) Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis. Intensive Care Med 44:323–336 CrossRef Klein SJ, Brandtner AK, Lehner GF et al (2018) Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis. Intensive Care Med 44:323–336 CrossRef
29.
Zurück zum Zitat Koyner JL, Davison DL, Brasha-Mitchell E et al (2015) Furosemide stress test and Biomarkers for the prediction of AKI severity. J Am Soc Nephrol 26:2023–2031 CrossRef Koyner JL, Davison DL, Brasha-Mitchell E et al (2015) Furosemide stress test and Biomarkers for the prediction of AKI severity. J Am Soc Nephrol 26:2023–2031 CrossRef
30.
Zurück zum Zitat Lu JCT, Coca SG, Patel UD et al (2009) Searching for genes that matter in acute kidney injury: a systematic review. Clin J Am Soc Nephrol 4:1020–1031 CrossRef Lu JCT, Coca SG, Patel UD et al (2009) Searching for genes that matter in acute kidney injury: a systematic review. Clin J Am Soc Nephrol 4:1020–1031 CrossRef
31.
Zurück zum Zitat Marx D, Metzger J, Pejchinovski M et al (2018) Proteomics and metabolomics for AKI diagnosis. Semin Nephrol 38:63–87 CrossRef Marx D, Metzger J, Pejchinovski M et al (2018) Proteomics and metabolomics for AKI diagnosis. Semin Nephrol 38:63–87 CrossRef
32.
Zurück zum Zitat Meersch M, Schmidt C, Hoffmeier A et al (2017) Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial. Intensive Care Med 43:1551–1561 CrossRef Meersch M, Schmidt C, Hoffmeier A et al (2017) Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial. Intensive Care Med 43:1551–1561 CrossRef
33.
Zurück zum Zitat Mishra J, Ma Q, Prada A et al (2003) Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 14:2534–2543 CrossRef Mishra J, Ma Q, Prada A et al (2003) Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 14:2534–2543 CrossRef
34.
Zurück zum Zitat Mishra J, Mori K, Ma Q et al (2004) Amelioration of ischemic acute renal injury by neutrophil gelatinase-associated lipocalin. J Am Soc Nephrol 15:3073–3082 CrossRef Mishra J, Mori K, Ma Q et al (2004) Amelioration of ischemic acute renal injury by neutrophil gelatinase-associated lipocalin. J Am Soc Nephrol 15:3073–3082 CrossRef
35.
Zurück zum Zitat Nguyen MT, Ross GF, Dent CL et al (2005) Early prediction of acute renal injury using urinary proteomics. Am J Nephrol 25:318–326 CrossRef Nguyen MT, Ross GF, Dent CL et al (2005) Early prediction of acute renal injury using urinary proteomics. Am J Nephrol 25:318–326 CrossRef
36.
Zurück zum Zitat Nguyen MT, Dent CL, Ross GF et al (2008) Urinary aprotinin as a predictor of acute kidney injury after cardiac surgery in children receiving aprotinin therapy. Pediatr Nephrol 23:1317–1326 CrossRef Nguyen MT, Dent CL, Ross GF et al (2008) Urinary aprotinin as a predictor of acute kidney injury after cardiac surgery in children receiving aprotinin therapy. Pediatr Nephrol 23:1317–1326 CrossRef
37.
Zurück zum Zitat Nickolas TL, Schmidt-Ott KM, Canetta P et al (2012) Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage a multicenter prospective cohort study. J Am Coll Cardiol 59:246–255 CrossRef Nickolas TL, Schmidt-Ott KM, Canetta P et al (2012) Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage a multicenter prospective cohort study. J Am Coll Cardiol 59:246–255 CrossRef
39.
Zurück zum Zitat Parikh CR, Jani A, Melnikov VY et al (2004) Urinary interleukin-18 is a marker of human acute tubular necrosis. Am J Kidney Dis 43:405–414 CrossRef Parikh CR, Jani A, Melnikov VY et al (2004) Urinary interleukin-18 is a marker of human acute tubular necrosis. Am J Kidney Dis 43:405–414 CrossRef
40.
Zurück zum Zitat Parr SK, Clark AJ, Bian A et al (2015) Urinary L‑FABP predicts poor outcomes in critically ill patients with early acute kidney injury. Kidney Int 87:640–648 CrossRef Parr SK, Clark AJ, Bian A et al (2015) Urinary L‑FABP predicts poor outcomes in critically ill patients with early acute kidney injury. Kidney Int 87:640–648 CrossRef
42.
Zurück zum Zitat Schnackenberg LK, Sun JC, Pence LM et al (2012) Metabolomics evaluation of hydroxyproline as a potential marker of melamine and cyanuric acid nephrotoxicity in male and female Fischer F344 rats. Food Chem Toxicol 50:3978–3983 CrossRef Schnackenberg LK, Sun JC, Pence LM et al (2012) Metabolomics evaluation of hydroxyproline as a potential marker of melamine and cyanuric acid nephrotoxicity in male and female Fischer F344 rats. Food Chem Toxicol 50:3978–3983 CrossRef
43.
Zurück zum Zitat Sparrow HG, Swan JT, Moore LW, Gaber AO, Suki WN (2019) Disparate outcomes observed within Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury stage. Kidney Int 95(4):905–913 CrossRef Sparrow HG, Swan JT, Moore LW, Gaber AO, Suki WN (2019) Disparate outcomes observed within Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury stage. Kidney Int 95(4):905–913 CrossRef
44.
Zurück zum Zitat Sun JC, Shannon M, Ando Y et al (2012) Serum metabolomic profiles from patients with acute kidney injury: a pilot study. J Chromatogr B Analyt Technol Biomed Life Sci 893:107–113 CrossRef Sun JC, Shannon M, Ando Y et al (2012) Serum metabolomic profiles from patients with acute kidney injury: a pilot study. J Chromatogr B Analyt Technol Biomed Life Sci 893:107–113 CrossRef
45.
Zurück zum Zitat Tampe B, Tampe D, Muller CA et al (2014) Tet3-mediated hydroxymethylation of epigenetically silenced genes contributes to bone morphogenic protein 7‑induced reversal of kidney fibrosis. J Am Soc Nephrol 25:905–912 CrossRef Tampe B, Tampe D, Muller CA et al (2014) Tet3-mediated hydroxymethylation of epigenetically silenced genes contributes to bone morphogenic protein 7‑induced reversal of kidney fibrosis. J Am Soc Nephrol 25:905–912 CrossRef
46.
Zurück zum Zitat Tampe B, Tampe D, Zeisberg EM et al (2015) Induction of Tet3-dependent epigenetic remodeling by low-dose hydralazine attenuates progression of chronic kidney disease. EBioMedicine 2:19–36 CrossRef Tampe B, Tampe D, Zeisberg EM et al (2015) Induction of Tet3-dependent epigenetic remodeling by low-dose hydralazine attenuates progression of chronic kidney disease. EBioMedicine 2:19–36 CrossRef
47.
Zurück zum Zitat Tampe B, Steinle U, Tampe D et al (2017) Low-dose hydralazine prevents fibrosis in a murine model of acute kidney injury-to-chronic kidney disease progression. Kidney Int 91:157–176 CrossRef Tampe B, Steinle U, Tampe D et al (2017) Low-dose hydralazine prevents fibrosis in a murine model of acute kidney injury-to-chronic kidney disease progression. Kidney Int 91:157–176 CrossRef
48.
Zurück zum Zitat Uehara T, Horinouchi A, Morikawa Y et al (2014) Identification of metabolomic biomarkers for drug-induced acute kidney injury in rats. J Appl Toxicol 34:1087–1095 CrossRef Uehara T, Horinouchi A, Morikawa Y et al (2014) Identification of metabolomic biomarkers for drug-induced acute kidney injury in rats. J Appl Toxicol 34:1087–1095 CrossRef
49.
Zurück zum Zitat Vaidya VS, Ford GM, Waikar SS et al (2009) A rapid urine test for early detection of kidney injury. Kidney Int 76:108–114 CrossRef Vaidya VS, Ford GM, Waikar SS et al (2009) A rapid urine test for early detection of kidney injury. Kidney Int 76:108–114 CrossRef
50.
Zurück zum Zitat Vanmassenhove J, Van Biesen W, Vanholder R et al (2019) Subclinical AKI: ready for primetime in clinical practice? J Nephrol 32:9–16 CrossRef Vanmassenhove J, Van Biesen W, Vanholder R et al (2019) Subclinical AKI: ready for primetime in clinical practice? J Nephrol 32:9–16 CrossRef
51.
Zurück zum Zitat Waikar SS, Liu KD, Chertow GM (2008) Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol 3:844–861 CrossRef Waikar SS, Liu KD, Chertow GM (2008) Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol 3:844–861 CrossRef
52.
Zurück zum Zitat Wang J, Zhou Y, Xu M et al (2011) Urinary metabolomics in monitoring acute tubular injury of renal allografts: a preliminary report. Transplant Proc 43:3738–3742 CrossRef Wang J, Zhou Y, Xu M et al (2011) Urinary metabolomics in monitoring acute tubular injury of renal allografts: a preliminary report. Transplant Proc 43:3738–3742 CrossRef
53.
Zurück zum Zitat Weiss RH, Kim KM (2012) Metabolomics in the study of kidney diseases. Nat Rev Nephrol 8:22–33 CrossRef Weiss RH, Kim KM (2012) Metabolomics in the study of kidney diseases. Nat Rev Nephrol 8:22–33 CrossRef
54.
Zurück zum Zitat Wu HL, Craft ML, Wang P et al (2008) IL-18 contributes to renal damage after ischemia-reperfusion. J Am Soc Nephrol 19:2331–2341 CrossRef Wu HL, Craft ML, Wang P et al (2008) IL-18 contributes to renal damage after ischemia-reperfusion. J Am Soc Nephrol 19:2331–2341 CrossRef
55.
Zurück zum Zitat Wynn TA, Ramalingam TR (2012) Mechanisms of fibrosis: therapeutic translation for fibrotic disease. Nat Med 18:1028–1040 CrossRef Wynn TA, Ramalingam TR (2012) Mechanisms of fibrosis: therapeutic translation for fibrotic disease. Nat Med 18:1028–1040 CrossRef
57.
Zurück zum Zitat Yamamoto T, Noiri E, Ono Y et al (2007) Renal L‑type fatty acid-binding protein in acute ischemic injury. J Am Soc Nephrol 18:2894–2902 CrossRef Yamamoto T, Noiri E, Ono Y et al (2007) Renal L‑type fatty acid-binding protein in acute ischemic injury. J Am Soc Nephrol 18:2894–2902 CrossRef
58.
Zurück zum Zitat Yoo J, Kim JH, Robertson KD et al (2012) Molecular modeling of inhibitors of human DNA methyltransferase with a crystal structure: discovery of a novel DNMT1 inhibitor. Adv Protein Chem Struct Biol 87:219–247 CrossRef Yoo J, Kim JH, Robertson KD et al (2012) Molecular modeling of inhibitors of human DNA methyltransferase with a crystal structure: discovery of a novel DNMT1 inhibitor. Adv Protein Chem Struct Biol 87:219–247 CrossRef
59.
Zurück zum Zitat Zgoda-Pols JR, Chowdhury S, Wirth M et al (2011) Metabolomics analysis reveals elevation of 3‑indoxyl sulfate in plasma and brain during chemically-induced acute kidney injury in mice: investigation of nicotinic acid receptor agonists. Toxicol Appl Pharmacol 255:48–56 CrossRef Zgoda-Pols JR, Chowdhury S, Wirth M et al (2011) Metabolomics analysis reveals elevation of 3‑indoxyl sulfate in plasma and brain during chemically-induced acute kidney injury in mice: investigation of nicotinic acid receptor agonists. Toxicol Appl Pharmacol 255:48–56 CrossRef
Metadaten
Titel
Akute Nierenschädigung: von Kreatinin zu KIM‑1?
verfasst von
M. Wallbach
B. Tampe
H. Dihazi
Prof. Dr. med. M. J. Koziolek
Publikationsdatum
18.04.2019
Verlag
Springer Medizin
Erschienen in
Die Innere Medizin / Ausgabe 6/2019
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-019-0602-y

Weitere Artikel der Ausgabe 6/2019

Die Innere Medizin 6/2019 Zur Ausgabe

Schwerpunkt: Biomarker in der Akutmedizin

Bedeutung von Biomarkern bei akuter Herzinsuffizienz

Einführung zum Thema

Biomarker in der Akutmedizin

Neu im Fachgebiet Innere Medizin

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Innere Medizin und bleiben Sie gut informiert – ganz bequem per eMail.