Epidemiologie und Ursachen für ein akutes Nierenversagen – Übergang in eine chronische Nierenschädigung

Die Grenzen verschwimmen schnell, wenn es um die ANV-Klassifikation geht, insbesondere zwischen prärenalen und renalen Ursachen. Es besteht ein enger Zusammenhang zwischen Mortalität und chronischer Nierenerkrankung. Aufgrund der hohen Inzidenz sollte ein ANV von klinisch tätigen Ärzten unmittelbar erkannt und ätiologisch eingeordnet werden können. Dieser Beitrag soll einen Überblick über die häufigsten Gründe eines ANV geben.

Abstract

Acute kidney injury (AKI) refers to an acute functional deterioration of the kidneys, which leads to retention of urinary substances, dysregulation of the electrolyte and acid-base balance, and disturbance of fluids. Although didactically helpful, the oversimplified AKI classification of prerenal/renal/postrenal is currently considered obsolete. Indeed, the boundaries blur quite quickly, particularly between prerenal and renal causes. Based on the AKI pathophysiology, it can be etiologically divided into decreased renal perfusion, postrenal obstruction and kidney specific injury or unspecific injury. AKI is a common event in hospitalized patients and associates strongly with mortality and chronic kidney disease (CKD). Today it is accepted that AKI and CKD are rather an individually variable continuum, than 2 distinct entities. If AKI has not regressed after 7 days, it is referred to as acute kidney disease (AKD). Persisting AKD for > 90 days is classified as CKD. The transition from AKD to CKD is the result of an incomplete and maladaptive repair process. Although follow-up of post-AKI patients is essential, optimal concepts still need to be developed.

Schlüsselwörter

akutes Nierenversagen - akute Nierenschädigung - akute Nierenerkrankung

Key words

acute renal failure - acute kidney injury - acute kidney disease

Publication History

Article published online:
28 February 2022

• Literatur

• 1 Kellum J, Lameire N, Aspelin P. et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2 (01) 1-138
• 2 Susantitaphong P, Cruz DN, Cerda J. et al. World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol 2013; 8: 1482-1493
• 3 Khadzhynov D, Schmidt D, Hardt J. et al. The Incidence of Acute Kidney Injury and Associated Hospital Mortality. Dtsch Arztebl Int 2019; 116: 397-404
• 4 Kister TS, Remmler J, Schmidt M. et al. Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system. PLoS One 2021; 16: e0254608
• 5 Hoste EA, Bagshaw SM, Bellomo R. et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 2015; 41: 1411-1423
• 6 Wonnacott A, Meran S, Amphlett B. et al. Epidemiology and outcomes in community-acquired versus hospital-acquired AKI. Clin J Am Soc Nephrol 2014; 9: 1007-1014
• 7 Prowle JR, Kirwan CJ, Bellomo R. Fluid management for the prevention and attenuation of acute kidney injury. Nat Rev Nephrol 2014; 10: 37-47
• 8 Busauschina A, Schnuelle P, van der Woude FJ. Cyclosporine nephrotoxicity. Transplant Proc 2004; 36: 229S-233S
• 9 Bridoux F, Cockwell P, Glezerman I. et al. Kidney injury and disease in patients with haematological malignancies. Nat Rev Nephrol 2021; 17: 386-401
• 10 Gines P, Schrier RW. Renal failure in cirrhosis. N Engl J Med 2009; 361: 1279-1290
• 11 Di Lullo L, Reeves PB, Bellasi A. et al. Cardiorenal Syndrome in Acute Kidney Injury. Semin Nephrol 2019; 39: 31-40
• 12 Latus J, Schwenger V, Schlieper G. et al. [Contrast medium-induced acute kidney injury-Consensus paper of the working group “Heart and Kidney” of the German Cardiac Society and the German Society of Nephrology]. Internist (Berl) 2021; 62: 111-120
• 13 George JN, Nester CM. Syndromes of thrombotic microangiopathy. N Engl J Med 2014; 371: 654-666
• 14 Scolari F, Ravani P. Atheroembolic renal disease. Lancet 2010; 375: 1650-1660
• 15 Pickkers P, Ostermann M, Joannidis M. et al. The intensive care medicine agenda on acute kidney injury. Intensive Care Med 2017; 43: 1198-1209
• 16 Bellomo R, Kellum JA, Ronco C. et al. Acute kidney injury in sepsis. Intensive Care Med 2017; 43: 816-828
• 17 Ostermann M, Zarbock A, Goldstein S. et al. Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference: A Consensus Statement. JAMA Netw Open 2020; 3: e2019209
• 18 Hoste E, Bihorac A, Al-Khafaji A. et al. Identification and validation of biomarkers of persistent acute kidney injury: the RUBY study. Intensive Care Med 2020; 46: 943-953
• 19 Chawla LS, Bellomo R, Bihorac A. et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol 2017; 13: 241-257
• 20 Lameire NH, Levin A, Kellum JA. et al. Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int 2021; 100: 516-526
• 21 Forni LG, Darmon M, Ostermann M. et al. Renal recovery after acute kidney injury. Intensive Care Med 2017; 43: 855-866
• 22 Heung M, Steffick DE, Zivin K. et al. Acute Kidney Injury Recovery Pattern and Subsequent Risk of CKD: An Analysis of Veterans Health Administration Data. Am J Kidney Dis 2016; 67: 742-752
• 23 James MT, Levey AS, Tonelli M. et al. Incidence and Prognosis of Acute Kidney Diseases and Disorders Using an Integrated Approach to Laboratory Measurements in a Universal Health Care System. JAMA Netw Open 2019; 2: e191795
• 24 Silver S, Adhikari N, Bell C. et al. Nephrologist Follow-Up versus Usual Care after an Acute Kidney Injury Hospitalization (FUSION). Clin J Am Soc Nephrol 2021;