Nephrologe最新文献

Acute kidney injury (AKI) is a frequent and severe complication in coronavirus disease 2019 (COVID-19) patients in the intensive care unit. The development of COVID-19 associated AKI is closely linked to the severity of the disease course. The main risk factor for kidney failure requiring kidney replacement therapy is the necessity for invasive ventilation, whereby the onset of renal failure is often closely associated with the timing of intubation. Additionally, the risk factors for a severe course of COVID-19 have been shown to also be risk factors for renal failure. AKI in COVID-19 shows a high mortality and in some patients leads to chronic kidney disease; however, full recovery of kidney function in survivors who need dialysis is not uncommon. With respect to prevention and treatment of renal failure associated with COVID-19, the same recommendations as for AKI from other causes are valid (Kidney Disease: Improving Global Outcomes, KDIGO bundles). Due to the large numbers of patients in the setting of overwhelmed resources, the availability of extracorporeal renal replacement procedures can become critical, especially since hypercoagulation is frequent in COVID‑19. In order to avoid triage situations, in some centers acute peritoneal dialysis was used as an alternative to extracorporeal procedures.

The aim of this article is to explain the clinical benefits of the growing knowledge about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In addition to the lungs, SARS-CoV‑2 can invade multiple cell types in other organs, such as the kidneys and replicate there. Important damaging pathways of the virus, such as vascular endotheliitis, thrombotic events and systemic cytokine release are still incompletely understood. Coronavirus disease 2019 (COVID-19) is a systemic disease that necessitates intensive medical care and in particular, internal medicine involvement and represents a major challenge for all disciplines of internal medicine. Among these, nephrology in particular is involved in the fight against COVID-19 in a variety of ways: urine investigations can provide indications of multiple organ involvement, endotheliitis, microthrombi and microcirculation damage, etc. Experience with low serum albumin levels and antithrombin III activity in nephrotic patients helps to point out the decreasing effects of loop diuretics and heparin to other specialist disciplines. Nephrological knowledge of the complications of hypoalbuminemia and "resistance" to diuretics must lead to an early implementation of renal replacement procedures in order to be able to prevent mechanical ventilation in COVID-19 intensive care patients with increased extracellular lung fluid. The kidneys can be used as a seismograph for severe courses of COVID-19 and nephrological knowledge can be brought to use to optimize the intensive medical care for critically ill patients. Both together have the potential to considerably reduce morbidity and mortality further.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections represent a particular risk for several groups of patients with nephrological diseases. Patients on dialysis represent a particularly vulnerable group during the SARS-CoV‑2 pandemic. Initial data from international registries show a much higher mortality of dialysis patients with SARS-CoV‑2 infections. Because of the substantial differences between the healthcare systems, (state) preventive measures and treatment possibilities etc., in the different countries worldwide, local and national registry data cannot be easily transferred. In order to gain a reliable overview of the prevalence and mortality of dialysis patients with SARS-CoV‑2 infection in Germany, the German Society of Nephrology implemented a national registry for dialysis patients with a SARS-CoV‑2 infection. Within this framework a standardized collection of these data is carried out on a weekly basis, which should enable a real-time overview of the case numbers and perhaps the acquisition of new scientific knowledge. Particularly in the current phase of the pandemic (autumn 2020), which is accompanied by a multiplication of the numbers of daily new-onset cases within only a few weeks, such data are highly relevant for the estimation and adjustment of the personnel, structural and organizational needs as well as the capacities for the treatment of patients.

When used correctly, modern ultrasound diagnostics are helpful for the nephrologist especially in emergency situations on the ward, in dialysis and in the emergency admission to quickly make the correct diagnosis or as a diagnostic gatekeeper to initiate the correct next diagnostic and therapeutic steps in a time-saving manner. In addition to conventional B‑mode/gray scale sonography and Doppler sonography, new ultrasound transducers with higher spatial resolution and above all contrast agent sonography have significantly expanded the technical possibilities and help nephrologists and internists to answer diagnostic and clinical questions. This particularly applies to the kidneys, which up to now could only be clarified by means of contrast-enhanced computed tomography or magnetic resonance imaging. This will allow the nephrologist in 2021 to amalgamate the clinical symptoms, imaging results and pathophysiological knowledge in an ideal, time-saving manner for the benefit of the patient.

Home hemodialysis (HHD) is the cornerstone of renal replacement therapy in Germany. From 1969, it enabled survival with a diagnosis that up to then had been fatal; however, with the development of a good network of dialysis centers, the knowledge and experience of HHD was increasingly lost. Today, HHD is practically no longer included in the education. Insufficient information and a lack of HHD services are the result. Currently, less than 0.8% of patients in Germany are treated with HHD. In the development of dialysis machines, the industry focused on stand-alone machines for the centers. This form of treatment hinders mobility and limits the activities of patients with renal insufficiency requiring dialysis. Starting with the Advancing American Kidney Health Initiative there has been a welcome momentum in the development of innovative, wearable and implantable artificial kidneys. This can improve the quality of life and reduce the mortality rate. The first initiatives have also emerged in Germany and Europe. These innovative devices and the associated transition in renal replacement therapy will solve many problems of the nephrology community, such as personnel shortages or the lack of donor organs and death on the waiting list and give patients independence and mobility. The cost burden on healthcare systems can be reduced. In addition, the immense water and electricity consumption will be dramatically reduced by the regenerative techniques of the new machines.

Sodium-glucose transport protein 2 inhibitors (SGLT2i, gliflozins) were originally developed for the treatment of type 2 diabetes; however, in mandatory approval studies, they demonstrated unexpected positive effects on cardiovascular endpoints and renal function. Several phase III studies published during the last year have investigated the effects of this drug class on chronic kidney disease and heart failure in diabetic and non-diabetic patients. The predominantly positive results have led to a continuing expansion of their clinical use. This article aims to provide an overview of the most recent endpoint studies on SGLT2i and show implications for practice, to present the state of knowledge on risks and side effects and to summarize current hypotheses on the mode of action of this class of drugs.

Acute kidney injury (AKI) is a frequent complication in coronavirus disease 2019 (COVID-19). It is often linked to progressive respiratory failure and is associated with increased morbidity and mortality. The AKI is presumably of multifactorial origin, whereby direct viral infestation of the kidneys also seems to be involved. Specific treatment procedures for AKI associated with COVID-19 are currently missing. In addition, the role of extracorporeal procedures in the treatment of COVID-19 could so far not be clarified. Latest data indicate persistent loss of renal function following COVID-19-associated AKI. Therefore, a re-evaluation of renal function following recovery from COVID-19 should be recommended.