Sm. Jakob et Fj. Frey, UREMIA - PATHOPHYSIOLOGIC IMPLICATIONS AN D INDICATION FOR RENAL REPLACEMENT THERAPY, Schweizerische medizinische Wochenschrift, 127(25), 1997, pp. 1077-1081
Mortality in intensive care unit patients with acute renal failure is
still high. The reasons for this are not fully understood. Renal failu
re without other failing organs does not lead to death if treatment is
adequate. Uremia is therefore thought to prevent spontaneous recovery
from and impedes the treatment of other organ failures. The reasons f
or this have been elucidated only partially. Of main importance are di
fferent kinetics and dynamics of endo- and xenobiotics in uremia. The
mechanisms that lead to altered kinetics in such patients are quite cl
early understood, while in the field of altered dynamics many question
s are open. It is also unclear which accumulating metabolites are resp
onsible for the different dynamics. This is the reason why parameters
that would indicate when to start a dialysis procedure in acute renal
failure are still lacking. Exceptions are substances known to lead to
death if they are present in high concentrations. These substances are
mainly potassium, salt and water.