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Erschienen in: Die Nephrologie 1/2021

22.12.2020 | Akutes Nierenversagen | Leitthema Zur Zeit gratis

COVID-19 und akute Nierenschädigung im Intensivbereich

verfasst von: Dr. med. Jan-Hendrik B. Hardenberg, Dr. med. Helena Stockmann, Prof. Dr. Kai-Uwe Eckardt, Prof. Dr. Kai M. Schmidt-Ott

Erschienen in: Die Nephrologie | Ausgabe 1/2021

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Zusammenfassung

Die akute Nierenschädigung („acute kidney injury“, AKI) ist eine häufige und schwere Komplikation bei COVID-19(„coronavirus disease 2019“)-Patient*innen auf der Intensivstation. Dabei zeigt sich eine enge Assoziation zwischen der Schwere des Krankheitsverlaufs von COVID-19 und dem Auftreten von Nierenversagen. Den Hauptrisikofaktor für ein nierenersatztherapiepflichtiges Nierenversagen stellt die Notwendigkeit einer invasiven Beatmung dar, wobei der Beginn des Nierenversagens häufig eng mit dem Intubationszeitpunkt assoziiert ist. Zusätzlich stellen Risikofaktoren für schwere COVID-19-Verläufe gleichzeitig Risikofaktoren für ein schweres Nierenversagen dar. AKI bei COVID-19 weist eine hohe Mortalität auf und führt bei einem Teil der Patient*innen zu anhaltender Niereninsuffizienz. Allerdings kommt es bei einem recht großen Teil der dialysepflichtigen Überlebenden zu einer Erholung der Nierenfunktion. Im Hinblick auf Vermeidung und Therapie des COVID-19-assoziierten Nierenversagens gelten bislang dieselben Empfehlungen wie für AKI anderer Ursachen (Kidney Disease: Improving Global Outcomes, KDIGO-Bundles). Bei hohem Patient*innenaufkommen und entsprechend ausgelasteten Ressourcen kann die Durchführung von extrakorporalen Nierenersatzverfahren im Kontext einer krankheitsassoziierten Hyperkoagulabilität kritisch werden. Zur Vermeidung von Triage-Situationen wurde in einzelnen Zentren die akute Peritonealdialyse als Alternative zu den extrakorporalen Verfahren eingesetzt.
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Metadaten
Titel
COVID-19 und akute Nierenschädigung im Intensivbereich
verfasst von
Dr. med. Jan-Hendrik B. Hardenberg
Dr. med. Helena Stockmann
Prof. Dr. Kai-Uwe Eckardt
Prof. Dr. Kai M. Schmidt-Ott
Publikationsdatum
22.12.2020
Verlag
Springer Medizin
Erschienen in
Die Nephrologie / Ausgabe 1/2021
Print ISSN: 2731-7463
Elektronische ISSN: 2731-7471
DOI
https://doi.org/10.1007/s11560-020-00471-1

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