Das atypische Hämolytisch-Urämische Syndrom in der kardiovaskulären Chirurgie

Kamla, Christine-Elena (2023): Das atypische Hämolytisch-Urämische Syndrom in der kardiovaskulären Chirurgie: eine seltene Ursache des postoperativen akuten Nierenversagens und ihr Zusammenhang mit der Aortenchirurgie. Dissertation, LMU München: Medizinische Fakultät

Abstract

The aim of this work is the research of the postoperative acute kidney injury (AKI) requiring renal replacement therapy (RRT), with emphasis on the prevalence of atypical haemolytic uremic syndrome (aHUS) in patients treated on the cardiothoracic ICU of the LMU University Hospital after cardiac surgery. Except for some few case reports, the correlation between cardiac surgery requiring cardio-pulmonary-bypass (CPB) and the manifestation of aHUS has not been described so far in the field literature. As the treatment of the AKI caused by aHUS widely varies from the management of the classical CSA-AKI (cardiac-surgery associated AKI) and because the early initiation of the treatment is essential for a positive outcome, the detailed analysis of this pathology is fully justified and imperative. The underlying hypothesis of this work is that in certain high-risk patients, there is a correlation between the intraoperative use of CPB, which leads to an activation of the complement system and the clinical manifestation of aHUS, causing AKI. In the beginning, there were analyzed all the patients who developed AKI requiring RRT in the early postoperative course after cardiac surgery. The target was to find out the significance of aHUS as a potential cause of postoperative AKI. Special attention was attached to the identification of the risk factors for developing aHUS. Demographic parameters, comorbidities, the surgical diagnosis and the unfolding of the surgical procedures were thoroughly analyzed. Because of the highly significant statistical correlation between the manifestation of aHUS and procedures performed on the thoracic aorta, the work was expanded by a detailed analysis of this certain subgroup. In this cohort too the primary endpoint was to identify potential risk factors for the postoperative manifestation of aHUS. The focus in this case went to the surgical procedure itself, as well as to the intraoperative course: the applied quantity of cardioplegic solution, the use of a (hypothermic) circulatory arrest and the exact time on the CPB. Among the secondary endpoints mention should be made of the correlation between postoperative aHUS and other complications (such as bleedings, need for a durable pacemaker, a.o.) and the outcome of aHUS patients after adequate treatment. The outcome-analysis was based on data regarding survival, persistent need of RRT and relevant laboratory parameters at discharge and 6 months after surgery.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Deutsch
• Datum der mündlichen Prüfung: 15. November 2023
• 1. Bericht­erstatter:in: Hagl, Christian