Akutes Nierenversagen infolge eines hepatorenalen Syndroms

ZUSAMMENFASSUNG

Das akute Nierenversagen (AKI: „acute kidney injury“) infolge eines hepatorenalen Syndroms (AKI-HRS) kommt nur bei Patienten mit Leberzirrhose und Aszites vor. AKI-HRS muss jedoch von anderen Ursachen des AKI abgegrenzt werden, die weitaus häufiger vorkommen. Zu nennen wären Volumenmangel, Infektionen, Gebrauch von tubulotoxischen Substanzen sowie Komorbiditäten einschließlich akuter Verschlechterungen vorbestehender chronischer Nierenerkrankungen anderer Genese, wie z. B. bei Diabetes, arterieller Hypertonie, Herzinsuffizienz und Glomerulonephritiden. Der aktuelle Expertenkonsensus hat die bisherigen Diagnosekriterien gelockert. Dennoch sollte die Diagnose eines AKI-HRS in klarer Abgrenzung zu einer vorbestehenden chronischen Nierenerkrankung oder hinsichtlich anderer Ursachen des AKI erfolgen. Dazu ist ein interdisziplinäres Management der Patienten unabdingbar. Volumenmanagement, Terlipressin und Albumin sind die führenden Säulen in der Therapie des AKI-HRS. Die Indikation zur Lebertransplantation sollte in allen Fällen geprüft werden und daher die schnelle Überweisung an spezialisierte Zentren nach sich ziehen, sofern die Patienten Transplantationskandidaten sein könnten. Die Notwendigkeit und Dauer einer Dialysetherapie müssen individuell geprüft werden.

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