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Krankheiten der Niere, der ableitenden Harnwege und des äußeren Genitales

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Pädiatrie

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Zusammenfassung

Die Aufgabe der Niere ist die Aufrechterhaltung der Homöostase sowie des Salz-Wasser- und des Säure-Basen-Haushaltes. Intrauterin hat die Urinproduktion wesentlichen Anteil an der Fruchtwassermenge. Bei intrauterin fehlender Urinproduktion kommt es zu sekundären Folgen durch mechanische Kompression des Fetus mit Mißbildungssyndromen. Die glomeruläre Filtrationsrate ist intrauterin einem langsamen Entwicklungsprozeß unterworfen. Bei Frühgeburten ab der 23. Schwangerschaftswoche ist eine ausreichende glomeruläre Filtration vorhanden. Die relative Expansion des Extrazellulärvolumens bei Frühgeborenen führt postnatal innerhalb weniger Tage zu einer erhöhten Ausscheidung von Flüssigkeit und NaCl. Dieser hohe Salzverlust in den ersten Lebenstagen ist nicht Ausdruck einer renal-tubulären Unreife, sondern Folge der Reduktion des Extrazellulärvolumens. Als Ausdruck dieser erhöhten NaCl-Exkretion ist die fraktionelle Natriumausscheidung bei Frühgeborenen deutlich höher als bei Reifgeborenen (1–7% vs. 1%). Die Adaptation des Flüssigkeitshaushaltes führt bei Neugeborenen innerhalb der ersten Lebenstage zu einem physiologischen Gewichtsverlust von bis zu 10% des Ausgangsgeburtsgewichtes. Die Balance zwischen Salz- und Wasserzufuhr und Neigung zur Reduktion des Extrazellulärvolumens ist Voraussetzung für die Konstanz der Natriumkonzentration im Plasma. Infolge einer nicht adäquaten Substitution an Wasser und Salz kann bei Frühgeborenen eine Hyponatriämie entstehen. Die Regulation des Säure-Basen-Haushaltes wird beeinflußt durch einen relativ hohen Bicarbonatverlust durch den proximalen Tubulus bei Frühgeborenen. Dieser ist bevorzugt bedingt durch eine relative Expansion des Extrazellulärvolumens. Die Sekretionsfähigkeit für H-Ionen ist auch bei einer Frühgeborenenniere schon voll vorhanden. Es besteht keine relative Unreife der Frühgeborenenniere bei der Regulation des Säure-Basen-Haushaltes. Intrauterin besteht keine Notwendigkeit, den Harn zu konzentrieren. Nach der Geburt entwickelt sich erst langsam die Fähigkeit, die Urinkonzentration über 350 mosmol/1 anzuheben. Dies ist partiell bedingt durch eine hohe Prostaglandinsekretion, die die Kochsalzresorption hemmt und die Permeabilität für Harnstoff entlang des Tubulus inhibiert. Innerhalb weniger Tage bis Wochen ändert sich dieser Zustand, und die Konzentrierungsfähigkeit steigt bis auf 600–800 mosmol/1 an.

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  1. M. Brandis
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  2. F. Hildebrandt
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  3. L. B. Zimmerhackl
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Editors and Affiliations

  1. Universitäts-Kinderklinik, Adenauerallee 119, 53113, Bonn, Deutschland

    Michael J. Lentze

  2. Universitäts-Kinderklinik, Schwanenweg 20, 24105, Kiel, Deutschland

    Jürgen Schaub

  3. Universitäts-Kinderklinik, Martinistr. 52, 20246, Hamburg, Deutschland

    Franz J. Schulte

  4. Universitäts-Kinderklinik, Langenbeckstr. 1, 55101, Mainz, Deutschland

    Jürgen Spranger

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Brandis, M., Hildebrandt, F., Zimmerhackl, L.B. (2001). Krankheiten der Niere, der ableitenden Harnwege und des äußeren Genitales. In: Lentze, M.J., Schaub, J., Schulte, F.J., Spranger, J. (eds) Pädiatrie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-12660-8_20

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  • DOI: https://doi.org/10.1007/978-3-662-12660-8_20

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-12661-5

  • Online ISBN: 978-3-662-12660-8

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