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Autonome Kreislaufregulation in der Urämie

Autonomic circulatory regulation in uremia

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Summary

Uremic autonomic neuropathy leads to impaired function of the baroreflex. The main defect, according to literature, is located in the afferent limb of the reflex arc and in the efferent cardiac vagus nerve, whereas the sympathetic part of the efferent arc is still intact. Own results, obtained in hemodialysis patients during orthostasis and volume removal induced sympathetic stimulation, showed a qualitatively and quantitatively adequate sympathetic response and also an adequate end organ receptor response. Autonomic nervous neuropathy predisposes to volume removal related symptomatic hypotension during hemodialysis treatment. In addition hemodialysis treatment per se induces a so far unexplained interference with sympathetic response to volume removal. The autonomic neuropathy also predisposes to development of hypertension in response to volume load.

Zusammenfassung

Die urämische autonome Neuropathie führt zu Störungen der Funktion des Baroreflexes. Aus der Literatur geht hervor, daß die wesentlichen Defekte den afferenten Reflexbogen sowie den efferenten cardialen Vagus betreffen, während die sympathische Funktion des efferenten Schenkels intakt bleibt. Eigene Befunde, an chronischen Hämodialysepatienten während Orthostase und Volumenentzug erhoben, belegen ebenfalls eine qualitativ und quantitativ adäquate Antwort des efferenten Sympathicus sowie eine erhaltene Ansprechbarkeit der Rezeptoren des Endorgans. Die autonome Neuropathie disponiert zur symptomatischen Hypotension bei Volumenentzug während der Dialysebehandlung. Zusätzlich führt die Hämodialysebehandlung selbst zu einer noch ungeklärten Hemmung der sympathischen Reaktion auf Volumenentzug. Die autonome Neuropathie disponiert bei Volumenbelastung zur arteriellen Hypertonie.

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Authors and Affiliations

  1. Klinikum der Joh.-Wolfg.-Goethe-Universität Zentrum f. Innere Medizin Abt. f. Nephrologie, Theodor-Stern-Kai 7, D-6000, Frankfurt/M. 70, Bundesrepublik Deutschland

    K. M. Koch, C. A. Baldamus, W. Ernst, W. Fassbinder, J. Georges & H. M. Brecht

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  1. K. M. Koch
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  2. C. A. Baldamus
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  3. W. Ernst
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  4. W. Fassbinder
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  5. J. Georges
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  6. H. M. Brecht
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Mit Unterstützung durch NIH-Contract NO1-AM-8-2227

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Koch, K.M., Baldamus, C.A., Ernst, W. et al. Autonome Kreislaufregulation in der Urämie. Klin Wochenschr 58, 1037–1042 (1980). https://doi.org/10.1007/BF01476874

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