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Die Nierenbeteiligung beim systemischen Lupus erythematodes

Renal disease in systemic lupus erythematosus

  • Leitthema
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Der Nephrologe Aims and scope

Zusammenfassung

Die Nierenbeteiligung beim systemischen Lupus erythematodes (SLE) ist eine schwerwiegende, prognostisch ungünstige Organbeteiligung. Ähnlich der „bunten“ klinischen Allgemeinsymptomatik des SLE bietet auch die Nierenbeteiligung eine breite Palette unterschiedlicher Verlausformen: von der asymptomatischen Mikrohämaturie bis zum rapid-progressiven Nierenversagen. Entsprechend den unterschiedlichen klinisch-nephrologischen Symptomen finden sich auch histologisch verschiedene Ausprägungen der Lupusnephritis, die in 6 Formen klassifiziert wird. Leichte Formen der Lupus-Nephritis erfordern keine immunsuppressive Therapie. Die diffus-proliferative Form hingegen (Typ IV), die aggressivste Form mit der schlechtesten Prognose, erfordert eine unverzügliche Behandlung. Neuere Ansätze zielen auf eine Remission schon in der frühen Induktionsphase bei verringerten Nebenwirkungen (z. B. Low-dose-Cyclophosphamid, Mycophenolat). Innovative Therapiekonzepte versprechen weitere Fortschritte in der Behandlung der Lupus-Nephritis.

Abstract

Renal involvment in patients with systemic lupus erythematosus displays a broad variety of clinical symptoms ranging from asymptomatic hematuria to rapidly progressing glomerulonephritis. The histopathological findings in renal biopsy are classified in six different forms reflecting this diversity. Mild forms of lupus nephritis do not require immunosuppressive therapy whereas the diffuse-proliferative lupus nephritis (classified as type IV) as the most aggressive form with the worst prognosis demands immediate treatment. Recent approaches aimed to achieve remission in the early induction phase with reduced side effects (e.g. low-dose cyclophosphamide, mycophenolate). Novel therapeutic concepts promise further improvement in lupus nephritis treatment.

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Schwarting, A. Die Nierenbeteiligung beim systemischen Lupus erythematodes. Nephrologe 3, 471–475 (2008). https://doi.org/10.1007/s11560-008-0247-7

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