Shock kidney
| Classification according to ICD-10 | |
|---|---|
| N17.1 | Acute kidney failure with acute cortical necrosis |
| ICD-10 online (WHO version 2019) | |
A shock kidney is a more or less pronounced kidney failure that occurs in connection with a manifest shock . The centralization occurring in the context of a shock event also leads to an initial vasoconstriction in the kidneys and thus to ischemia of the kidney tissue. If the urine volume decreases and / or the retention parameters increase in the course of a shock event, a shock kidney should be considered.
Pathogenesis
A hypovolemia , cardiogenic shock (triggered by heart failure state of shock), but also a reduction in venous return to the heart (collectively, "circulatory" reasons) , are the main cause for a shock kidney and a acute renal failure . The centralization occurring in the context of a shock event also leads to an initial vasoconstriction in the kidneys and thus to ischemia of the kidney tissue. The renal cortex is affected to a disproportionately large extent, which can significantly reduce urine production or even stop it. Microthrombi are formed in the glomerular capillaries .
Diagnosis and course
When the urine volume is reduced and / or the retention parameters increase (levels of urinary substances such as creatinine in the blood) in the context of a more or less pronounced shock, a shock kidney should be considered in the differential diagnosis. Sonographically , the echogenicity of the renal cortex is typically diffusely increased and that of the medullary pyramids is reduced.
If urine production drops or stops as a result of shock and the associated reduction in blood flow to the renal cortex ( anuria or oliguria ) , one speaks of the "oliguric" or "anuric" (in some literature also "oligoanuric") phase. If the kidney function recovers in the further course, polyuria (increased urine volume) occurs. In this “polyuric” stage, the diuresis is increased, but the urine concentration is still reduced. The retention parameters often fall at this stage. A restitutio ad integrum (healing) is possible.
therapy
In the phase of reduced diuresis, hemodialysis is indicated in many cases up to the onset of the polyuric phase . In the polyuric phase, care should be taken to give sufficient fluids, because in this stage the kidneys are not able to concentrate the urine appropriately according to the hydration state of the body.
Individual evidence
- ↑ a b c Leo Latasch , Eva Knipfer (Ed.): Anesthesia, intensive medicine, intensive care. 2nd, completely revised edition. Elsevier, Urban & Fischer, Munich 2004, ISBN 3-437-25717-X , pp. 154ff., Here online
- ↑ Reinhard Büttner, Carlos Thomas: General Pathology. Schattauer, Stuttgart a. a. 2003, ISBN 3-7945-2229-X , p. 252, online here .
- ↑ Hanns-Wolf Baenkler: Internal Medicine. Special edition. Thieme, Stuttgart 2001, ISBN 3-13-128751-9 , p. 253, online here .
- ^ Günter Schmidt (ed.): Sonographic differential diagnosis. Teaching atlas for systematic image analysis with over 2500 examples of findings. Thieme, Stuttgart a. a. 2002, ISBN 3-13-126141-2 , p. 299, online here .