A renal failure (synonym: renal failure , renal impairment ) means the deterioration or loss of filtrativen renal function .
The term renal failure was coined and defined by Sándor von Korányi in 1897 . At that time, renal insufficiency was seen as both glomerular insufficiency and tubule insufficiency. Renal insufficiency was defined as the “normal deviation of kidney function, that is, urinary secretion when the entire organ is 'insufficient'.” The function of the “tangles” (glomeruli) and the function of the “tubules” (tubules) were therefore considered to be affected . "If both partial functions are impaired, renal failure occurs". One should therefore think of the possibility "if only one [sic!] Of the two components, only the tubules or only the glomeruli are insufficient, provided that the other partner is fully functional."
Today, however, kidney failure is only understood to mean the decline in the filter function of the glomeruli or podocytes , so that the kidneys are no longer able to excrete about 60 grams of solid substances (especially urea) per 24 hours, as is normally the case. The severity of renal insufficiency and retention of urea is assessed using the glomerular filtration rate ( GFR ) or creatinine clearance . Here, tubular reabsorption and thus secondary urine production are not taken into account. According to today's view, oliguria or anuria (as a compensatory increase in the tubular re-absorption rate ) is not an indication of renal insufficiency. The polyuria was correctly recognized 100 years ago as a consequence of a "tubular insufficiency".
Franz Volhard already knew the difference between renal renal insufficiency and extrarenal renal insufficiency . The extrarenal renal insufficiency ("extrarenal kidney syndrome" according to Wilhelm Nonnenbruch) is the "extrarenal-related disorder of kidney function". There is a difference “whether a phenomenon is to be regarded as the result of the dysfunction of the kidney or as the result of its disease and can also occur without a disturbance of the kidney function.” So there is renal insufficiency without kidney disease and kidney disease without renal insufficiency.
Renal clearance is the volume of plasma that is cleared of a specific substance by the kidneys within a specified period of time. According to this old definition, clearance is the result of the interaction of glomeruli and tubules. According to the new concept, creatinine clearance is equated with glomerular filtration, because creatinine is not reabsorbed by the tubules. However, this requirement that creatinine cannot be absorbed is not met with every reduction in cardiac output, because in these cases there is a compensatory increase in the tubular reabsorption of the primary urine (= GFR) (with all urinary substances) up to anuria.
There are two forms of kidney failure over time, acute kidney failure and chronic kidney failure . In both cases, the kidneys no longer function qualitatively or only to a very limited extent (urine production can remain quantitatively unchanged or even be increased). The difference in the forms lies in the time span and the prognosis . Acute kidney failure occurs either as part of an acute worsening of a long-standing, pre-existing kidney disease such as chronic glomerulonephritis , diabetic or hypertensive kidney damage, as a result of long-term drug abuse (especially analgesic abuse , see analgesic nephropathy , uremia toxin , nephrotoxin ) or an acute autoimmune episode (acute , Accident, infections, surgery, sepsis etc.). In most cases, it is reversible in principle and does not necessarily have to develop into terminal kidney failure.
A distinction is made according to the duration of the disturbance:
- prerenal renal failure (a hypovolämisches problem as a result of reduced cardiac output ; Synonyms: painless renal disease , especially renal kidney syndrome , Nonnenbruch syndrome , extrarenal renal failure )
- renal kidney failure (as a result of actual kidney disease ; very rare, only 3 percent in acute kidney failure)
- postrenal kidney failure (as a result of mechanical obstruction of the lower urinary tract; also rare)
Acute kidney failure
The acute renal failure is a serious, intense medical disease with still high mortality . A causal treatment is usually not possible. The treatment consists of optimizing the circulatory situation and kidney blood flow, omitting drugs that are harmful to the kidneys and removing obstacles to drainage in the urinary tract .
Chronic kidney failure
Chronic kidney failure can ultimately mean the final functional abandonment of the kidneys as it progresses to the terminal stage, although certain partial functions can still be active. The most common causes in the industrialized nations are type 2 diabetes mellitus and high blood pressure due to lack of exercise and malnutrition; Other causes are chronic, often undiscovered inflammation and infections of the kidneys, narrowing of the lower urinary tract and congenital kidney diseases such as cystic kidneys .
Chronic kidney failure develops over months to years. Symptoms usually only appear at a very advanced stage. Those affected are primarily at risk from complications of the cardiovascular system, such as heart attacks , strokes and circulatory disorders . In addition, there is a risk of kidney function worsening into the end stage of the disease requiring dialysis . Without treatment, decompensation with uremia and thus uremic coma ( coma uraemicum ) occurs in the final stage . Changes in lifestyle, strict drug control of blood pressure and treatment of concomitant diseases make it possible in many cases to inhibit or stop the progression of chronic kidney failure and thus prevent dialysis treatment. It is all the more important to detect the disease as early as possible, which can be done with a simple blood and urine test.
Terminal kidney failure
Laboratory values for kidney failure
|Urinary osmolarity (mosmol / kg)||90-900||> 500||<350|
|BUN / creatinine||~ 10||> 20||> 10|
|Urine Na mmol / l||40-80||<20||> 30|
|fractional sodium excretion (%)||1-3||<1||> 3|
- Heinz Krosch: Pro memoria Franz Volhard. In: Hans Erhard Bock , Karl Heinz Hildebrand, Hans Joachim Sarre (eds.): Franz Volhard - memories. Schattauer Verlag, Stuttgart / New York 1982, ISBN 3-7845-0898-X , p. 195.
- Franz Volhard: The double-sided haematogenic kidney diseases (Bright's disease). Springer-Verlag, Berlin / Heidelberg 1918, 576 pages plus appendix, reprint from III. Volume of the manual of internal medicine (edited by L. Mohr and Rudolf Staehelin), ISBN 978-3-662-42272-4 , pp. 37-39 and 58.
- Joachim Frey : Diseases of the kidneys, the water and salt balance, the urinary tract and the male sexual organs. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 893-996, here: pp. 916 f. ( Renal insufficiency, uremia ).
- See also Joachim Frey : Filtration diuresis as an expression of relative and absolute tubular insufficiency. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, p. 922 f.
- Franz Volhard : The double-sided haematogenic kidney diseases (Bright's disease). Springer-Verlag, Berlin / Heidelberg 1918, print from the 3rd volume of the manual of internal medicine (editors: L. Mohr and Rudolf Staehelin ), ISBN 978-3-662-42272-4 , pp. 55 and 58.
- Franz Volhard : The double-sided haematogenic kidney diseases (Bright's disease). Springer-Verlag, Berlin / Heidelberg 1918, 576 pages plus appendix, reprint from III. Volume of the manual of internal medicine (edited by L. Mohr and Rudolf Staehelin ), ISBN 978-3-662-42272-4 , p. IV in the foreword.
- Franz Volhard : The bilateral hematogenous kidney diseases . In: Gustav von Bergmann , Rudolf Staehelin (Ed.): Handbook of internal medicine. 2nd Edition. Springer-Verlag, Berlin / Heidelberg 1931, Volume 6, ISBN 978-3-662-42701-9 (reprint), 2140 pages.
- Johanna Bleker : The history of kidney diseases , Boehringer Mannheim GmbH, Mannheim 1972, p. 7 f.
- Maxim Zetkin , Herbert Schaldach: "Dictionary of Medicine", 14th edition, Volume LZ, Verlag Gesundheit, Berlin 1990, ISBN 3-333-00588-3 , ISBN 3-333-00594-8 , pp. 1485f.
- "extra renal kidney syndrome" by Wilhelm Nonnenbruch : "The double-sided kidney diseases," Ferdinand Enke Verlag , Stuttgart 1949, pp 170-192.
- "Nonnenbruch Syndrome" according to Maxim Zetkin , Herbert Schaldach: "Dictionary of Medicine", 15th edition, Ullstein Mosby, Berlin 1992, ISBN 3-86126-015-8 , ISBN 3-86126-018-2 , p. 1494 . also in : Günter Thiele (ed.): "hand Dictionary of medicine", Volume LR, Urban & Schwarzenberg , Munich, Vienna, Baltimore undated, p 1744th
- Maxim Zetkin , Herbert Schaldach: "Dictionary of Medicine", 15th edition, Ullstein Mosby, Berlin 1992, ISBN 3-86126-015-8 , ISBN 3-86126-018-2 , p. 1484.
- Maxim Zetkin , Herbert Schaldach: "Dictionary of Medicine", 14th edition, 2 volumes, volume L – Z, Verlag Gesundheit, Berlin 1990, ISBN 3-333-00588-3 , ISBN 3-333-00594-8 , p 1486.
- Thomas Hamp, David Weidenauer: Textbook tertiary emergency and intensive medicine. 2nd Edition. Springer, 2012, ISBN 978-3-7091-1012-6 .
- Richard Daikeler, idols Use, Sylke Waibel: diabetes. Evidence-based diagnosis and therapy. 10th edition. Kitteltaschenbuch, Sinsheim 2015, ISBN 978-3-00-050903-2 , pp. 152–155 ( diabetic nephropathy ).