Gabriel A, Müller E, Tarnow J
Institut für Klinische Anaesthesiologie, Heinrich-Heine-Universität Düsseldorf.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2001 Mar;36(3):134-42. doi: 10.1055/s-2001-11814.
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.
急性肾衰竭是多种损伤机制的常见结果。急性肾衰竭的预防和个体化治疗在麻醉学和重症医学中至关重要。药物治疗的效果非常有限。利尿剂可增加尿量，但既不能改善患者的临床病程，也不能改善已确诊急性肾衰竭的预后。多巴胺和利钠肽对急性肾衰竭的预防和治疗无效。钙通道阻滞剂在尸体肾移植中有价值。渗透性利尿剂可防止血红蛋白和肌红蛋白晶体在肾小管内沉淀；它们在尸体肾移植中也有一定价值。实验研究探讨了促进肾小管上皮细胞再生的可能性。尽管体外研究以及在动物模型中使用各种生长因子的研究取得了有前景的结果，但这些结果在急性肾衰竭患者中无法重现。肾脏中一氧化氮的生理学尚未完全了解。在对脂质过氧化及其潜在药理学意义的理解方面取得了实际进展。确保高质量患者护理的关键仍然是对高危患者进行警惕识别，并努力避免使用肾毒性物质以及避免可能导致潜在肾损伤的情况。
