Ergebnisse Der Inneren Medizin Und Kinderheilkunde: Neue Folge
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Anhand eigener klinischer Beobachtungen und experimenteller Unter- suchungen sowie auf Grund einer Literaturiibersicht wird die Notwendigkeit und Moglichkeit einer Trennung von extrarenaler Azotiimie (e. A.) und extrarenalem Nierensyndrom (e. Ns.) besprochen. Auf die Unterscheidung der e. A. und des e. Ns. von der akuten Niereninsuffizienz bei akuten degenerativen Nierenschaden (akute Nephrose) nach Intoxikationen, Infektionen, Trauma, unvertraglichen Bluttransfusionen usw. wird hingewiesen. Die pathophysiologischen Besonder- heiten der e. A. und des e. Ns. werden besonders unter Beriicksichtigung von Clearance-Untersuchungen dargestellt. Es wird weiterhin erwahnt, daB sich e. A. und e. Ns. nicht immer voneinander abgrenzen lassen. Bei den extrarenalen Azotamien ist die Nierenfunktionsfahigkeit voll erhalten. Sie entstehen aus dem Mif3verhaltnis zwischen normaler Nierenleistung und einem Uberangebot an harnpflichtigen Substanzen oder einem Mangel an Losungswasser. Ein Uberangebot an harnpflichtigen Substanzen (Rest-N-Fraktionen) liegt vor bei den zentralnervos ausgelosten Anderungen des EiweiBstoffwechsels und bei ver- mehrtem Angebot von EiweiB bzw. dessen Abbauprodukten nach Operationen und intestinalen Blutungen. Eine extrarenale Azotamie durch vermindertes Angebot von Fliissigkeit an die Nieren findet sich bei exsiccotischen Zustanden sowie bei Herzinsuffizienz. Auch bei Nierenkrankheiten kann es zu einer zusatzlichen Azot- amie durch einen inadaquat hohen EiweiBzerfall oder durch Fliissigkeitsmangel kommen. Die Anwendung des Begriffes extrarenales Nierensyndrom wird einmal im Hin- blick auf die extrarenale Azotamie und die akute Nephrose eingeschrankt, zum anderen jedoch erweitert auf die infolge nervaler und hormonaler Einfliisse auf- tretendcn StOrungen der N ierenfunktion ohne morphologische N ierenveranderungen. Entsprechende klinische und experimentelle Beobachtungen werden mitgeteilt.
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