Zusammenfassung.
Das akute Nierenversagen ist die gemeinsame Endstrecke vielfältiger Schädigungsereignisse.
Die Prophylaxe und differenzierte Therapie dieses Krankheitsbildes ist in der Anästhesie
und Intensivmedizin von großer Bedeutung. Eine pharmakologische Beeinflussung des
akuten Nierenversagens ist nur in engen Grenzen möglich. Diuretika steigern zwar den
Harnfluss, verbessern aber weder den Verlauf noch die Prognose des akuten Nierenversagens.
Dopamin und natriuretische Peptide sind in der Prophylaxe und Behandlung nicht indiziert.
Calcium-Antagonisten spielen lediglich bei der Nierentransplantation eine Rolle. Osmodiuretika
verhindern die intratubuläre Präzipitation von Hämoglobin und Myoglobin; sie haben
auch bei der Nierentransplantation prophylaktischen Wert. Experimentelle Ansätze zur
Förderung der Regeneration der Tubuluszelle durch verschiedene Wachstumsfaktoren sind
in vitro und im Tierversuch zwar vielversprechend, doch konnte ihr Nutzen bei der
klinischen Applikation nicht belegt werden. Die Physiologie von Stickstoffmonoxid
ist in der Niere noch unzureichend untersucht. Fortschritte zeichnen sich beim Verständnis
der Lipidperoxidationsprozesse und ihrer pharmakologischen Beeinflussung ab. Entscheidend
für die Klinik bleiben die rechtzeitige Erkennung des Risikopatienten und die konsequente
Vermeidung nierenschädigender Situationen und Noxen.
Rational Pharmacotherapy and Experimental Strategies in the Treatment of Acute Renal
Failure.
Acute renal failure is the common result of various damaging mechanisms. Prophylaxis
and differentiated therapy of acute renal failure are of outmost importance in anaesthesiology
and intensive care medicine. The efficiency of pharmacotherapy is narrowly limited.
Diuretics increase the urine output, but they do neither ameliorate the clinical course
of the patient nor the prognosis of established acute renal failure. Dopamine and
natriuretic peptides have no use in prevention and treatment of acute renal failure.
Calcium-channel-blockers are valuable in cadaveric kidney transplantation. Osmodiuretics
prevent intratubular precipitation of hemoglobin and myoglobin crystals; they also
have some value in cadaveric kidney transplantation. Experimental studies investigated
the possibility to enhance the regeneration of the tubular epithelial cell. Whereas
in vitro studies and studies in animal models using various growth factors yielded
promising results, these could not be reproduced in patients with acute renal failure.
The physiology of NO in the kidney is incompletely understood. Actual progress is
made in the understanding of lipid peroxidation and potential pharmacological implications.
The mainstay for the assurance of high-quality patient care remain a vigilant
identification of the patient at risk and an arduous search to avoid nephrotoxic
substances and situations implicating potential renal damage.
Schlüsselwörter:
Akutes Nierenversagen - Pharmakotherapie - Wachstumsfaktoren - Lipidperoxidation
Key words:
Acute renal failure - Pharmacotherapy - Growth factors - Lipid peroxidation
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Dr. med. Andrea Gabriel
Institut für Klinische Anaesthesiologie
Heinrich-Heine-Universität
Moorenstr. 5
40225 Düsseldorf
