Akutes Transplantatnierenversagen – Prärenale, intrarenale und postrenale Ursachen

Ein Transplantatnierenversagen kann nach dem Zeitpunkt des Auftretens nach der Transplantation und der Lokalisation der Ursache differenzialdiagnostisch eingeordnet werden. Bei den prärenalen Ursachen sind neben einer Infektion und einer Hypovolämie nach einer Nierentransplantation insbesondere das „cytokine-release-syndrome“ im Rahmen von Antikörpergaben sowie Gefäß- und Anastomosenprobleme auf der Spender- wie Empfängerseite zu nennen. Als intrarenale Ursachen ist die akute Abstoßung in den verschiedenen histologischen Formen, die akute Calcineurininhibitortoxizität sowie die akute interstitielle Nephritis aufzuführen. Lymphozelen und Ureterobstruktionen sind häufige Gründe für ein postrenales Transplantatversagen mit zu prüfender Operationsindikation. Bei allen Formen des akuten Transplantatversagens ist neben der notwendigen exakten Anamnese und klinischen Untersuchung die Sonografie die primäre, baldmöglichst einzusetzende apparative Untersuchungsmethode.

After renal transplantation, the main causes of kidney allograft dysfunction can be classified by time after transplantation and by the affected region of renal anatomy. Prerenal acute graft dysfunction induced by infection and hypovolemia is frequent. In particular, after kidney transplantation cytokine-release-syndrome caused by induction agents as well as vascular or anastomotic problems (from donor or recipient) play an important role. The main causes of intrarenal renal failure after transplantation are the different forms of acute rejection, calcineurin inhibitor nephrotoxicity and the acute interstitial nephritis. Lymphocele and ureteral obstruction often cause postrenal renal graft failure. Clinical symptoms and signs of failure must be carefully monitored. Ultrasound is the main component of diagnostic tools in all causes of dysfunction.

Key words

renal allograft dysfunction - differential diagnosis - prerenal - intrarenal - postrenal - acute rejection - calcineurin inhibitor nephrotoxicity

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