Behandlung und Progressionsbeeinflussung des akuten Nierenversagens

Das akute Nierenversagen stellt mit ca. 13,3 Mio. Patienten pro Jahr eine der größten Herausforderungen für Gesundheitssysteme weltweit dar [1]. Die häufig multifaktorielle Genese und komplexe pathophysiologische Mechanismen haben bisher die Entwicklung kausaler Therapieoptionen erschwert. Die Beeinflussung der Progression rückt ins Zentrum der Forschungen und es scheint nun auch eine gezielte Behandlung des ANV in greifbare Nähe zu rücken.

Abstract

Acute kidney injury (AKI) represents one of the greatest global health challenges and is associated with high mortality. The often multifactorial etiology and complex pathophysiological mechanisms have so far hampered the development of causal therapeutic options. The treatment should be stage-adapted according to the current KDIGO guideline: avoid nephrotoxicity, optimize volume status and perfusion pressure, monitor serum creatinine, urine output and proteinuria. New insights into the influence of mitochondrial dysfunction and cellular senescence in AKI, well-defined study endpoints, and innovations through nanotechnology may enable targeted drug-based AKI therapy in the future. Especially the weeks following an AKI are a vulnerable phase and crucial for progression management.

Schlüsselwörter

akutes Nierenversagen - medikamentöse Therapie - Progressionsbeeinflussung - Nephrotoxizität - nephrologische Betreuung

Key words

acute kidney injury - drug therapy - progression management - nephrotoxicity - nephrologist follow-up

Publication History

Article published online:
28 February 2022

• Literatur

• 1 Kellum J, Fuhrman D. The handwriting is on the wall: there will soon be a drug for AKI. Nat Rev Nephrol 2018; 15: 65-66
• 2 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
• 3 Mehta RL, Awdishu L, Davenport A. et al. Phenotype standardization for drug-induced kidney disease. Kidney Int 2015; 88 (02) 226-234
• 4 Kane-Gill S, Kirisci L, Verrico MM. et al. Analysis of risk factors for adverse drug events in critically ill patients*. Crit Care Med 2012; 40: 823-828
• 5 Kane-Gill SL. Nephrotoxin Stewardship. Crit Care Clin 2021; 37 (02) 303-320
• 6 Martin M, Wilson FP. Utility of Electronic Medical Record Alerts to Prevent Drug Nephrotoxicity. Clin J Am Soc Nephrol 2019; 14 (01) 115-123
• 7 Semler MW, Self WH, Wanderer JP. et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med 2018; 378: 829-839
• 8 Self WH, Semler MW, Wanderer JP. et al. Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med 2018; 378: 819-828
• 9 Guo Y, Ni J, Chen S. et al. MicroRNA-709 mediates acute tubular injury through effects on mitochondrial function. J Am Soc Nephrol 2018; 29: 449-461
• 10 Poyan Mehr A, Tran MT, Ralto KM. et al. De novo NAD+ biosynthetic impairment in acute kidney injury in humans. Nat Med 2018; 24: 1351-1359
• 11 Katsyuba E, Mottis A, Zietak M. et al. De novo NAD+ synthesis enhances mitochondrial function and improves health. Nature 2018; 563: 354-359
• 12 Husain-Syed F, Ferrari F, Sharma A. et al. Persistent decrease of renal functional reserve in patients after cardiac surgery-associated acute kidney injury despite clinical recovery. Nephrol Dial Transplant 2019; 34 (02) 308-317
• 13 Côté JM, Murray PT, Rosner MH. New drugs for acute kidney injury. Curr Opin Crit Care 2020; 26 (06) 525-535
• 14 Basso N, Terragno NA. History about the discovery of the renin-angiotensin system. Hypertension 2001; 38 (06) 1246-1249
• 15 Tumlin JA, Murugan R, Deane AM. et al. Angiotensin II for the Treatment of High-Output Shock 3 (ATHOS-3) Investigators. Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II. Crit Care Med 2018; 46 (06) 949-957
• 16 Yamada H, Doi K, Tsukamoto T. et al. Low-dose atrial natriuretic peptide for prevention or treatment of acute kidney injury: a systematic review and meta-analysis. Crit Care 2019; 23 (01) 41
• 17 Tang W, Huang J, Huang X. et al. Effect of alkaline phosphatase on sepsis-associated acute kidney injury patients: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99 (04) e18788
• 18 Walker VJ, Agarwal A. Targeting Iron Homeostasis in Acute Kidney Injury. Semin Nephrol 2016; 36 (01) 62-70
• 19 Corteville D, Still R, Gabor S. et al Efficacy and Safety of QPI-1002 (QPI) for Prevention of AKI Following Cardiac Surgery. American Society of Nephrology. Im Internet (Stand: 21.12.2021): https://www.asn-online.org/education/kidneyweek/2017/program-abstract.aspx?controlId=2827251
• 20 Porrini E, Ruggenenti P, Luis-Lima S. et al. Author Correction: Estimated GFR: time for a critical appraisal. Nat Rev Nephrol 2015; 15: 121
• 21 Zhao Y, Pu M, Wang Y. et al. Application of nanotechnology in acute kidney injury: From diagnosis to therapeutic implications. J Control Release 2021; 336: 233-251
• 22 Olson ES, Ortac I, Malone C. et al. Ultrasound Detection of Regional Oxidative Stress in Deep Tissues Using Novel Enzyme Loaded Nanoparticles. Adv Healthc Mater 2017; 6 (05)
• 23 Zhang C, Shang Y, Chen X. et al. Supramolecular Nanofibers Containing Arginine-Glycine-Aspartate (RGD) Peptides Boost Therapeutic Efficacy of Extracellular Vesicles in Kidney Repair. ACS Nano 2020; 14 (09) 12133-12147
• 24 See EJ, Jayasinghe K, Glassford N. et al. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int 2019; 95 (01) 160-172
• 25 Brouwer WP, Duran S, Kuijper M. et al. Hemoadsorption with CytoSorb shows a decreased observed versus expected 28-day all-cause mortality in ICU patients with septic shock: a propensity-score-weighted retrospective study. Crit Care 2019; 23 (01) 317
• 26 Boss K, Jahn M, Wendt D. et al. Extracorporeal cytokine adsorption: Significant reduction of catecholamine requirement in patients with AKI and septic shock after cardiac surgery. PLoS One 2021; 16 (02) e0246299
• 27 Soares DM, Pessanha JF, Sharma A. et al. Delayed Nephrology Consultation and High Mortality on Acute Kidney Injury: A Meta-Analysis. Blood Purif 2017; 43 (01) 57-67
• 28 Harel Z, Wald R, Bargman JM. et al. Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors. Kidney Int 2013; 83 (05) 901-908
• 29 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 (04) e191795
• 30 James MT, Bhatt M, Pannu N. et al. Long-term outcomes of acute kidney injury and strategies for improved care. Nat Rev Nephrol 2020; 16 (04) 193-205
• 31 Sayour AA, Korkmaz-Icöz S, Loganathan S. et al. Acute canagliflozin treatment protects against in vivo myocardial ischemia-reperfusion injury in non-diabetic male rats and enhances endothelium-dependent vasorelaxation. J Transl Med 2019; 17 (01) 127
• 32 Neuen BL, Young T, Heerspink HJ. et al. SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2019; 7 (11) 845-854
• 33 Xu J, Zhou L, Liu Y. Cellular Senescence in Kidney Fibrosis: Pathologic Significance and Therapeutic Strategies. Front Pharmacol 2020; 11: 601325
• 34 Boss K, Kribben A. Vom akuten Nierenversagen in die chronische Niereninsuffizienz. Nephrologe 2019; 14: 248-254
• 35 Levey AS. Defining AKD: The Spectrum of AKI, AKD, and CKD. Nephron 2021; 1-4
• 36 Chawla LS, Bellomo R, Bihorac A. et al. Acute Disease Quality Initiative Workgroup 16. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol 2017; 13 (04) 241-257
• 37 Ronco C, Bellomo R, Kellum J. Understanding renal functional reserve. Intensive Care Med 2017; 43 (06) 917-920
• 38 Sharma A, Mucino MJ, Ronco C. Renal functional reserve and renal recovery after acute kidney injury. Nephron Clin Pract 2014; 127 (01) 94-100