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Membranöse Glomerulonephritis

  • Schwerpunkt: Glomerulonephritis
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Zusammenfassung

Die membranöse Glomerulonephritis ist die häufigste Ursache für ein nephrotisches Syndrom bei Erwachsenen. Zumeist liegt eine idiopathische Form ohne Nachweis eines ursächlichen Faktors vor. Sekundäre Formen treten als "Begleitnephritis" von entzündlichen und neoplastischen Erkrankungen auf. Die Prognose der idiopathischen Form ist bei einer Spontanremissionsrate von ca. 30% oft günstig. In einem Drittel der Fälle kommt es aber zum Auftreten einer terminalen Niereninsuffizienz. Dabei bilden eine schwere Proteinurie, arterielle Hypertonie, höheres Lebensalter, männliches Geschlecht und eine eingeschränkte Nierenfunktion Risikofaktoren für einen ungünstigen Verlauf. Ein ACE-Hemmer und/oder Angiotensin-II-Rezeptorblocker (Zielblutdruck ≤130/80 mmHg) sollte unbedingt zur Reduktion der Proteinurie eingesetzt werden. Vor der Entscheidung über eine immunsuppressive Therapie sollte zumeist für ca. 6 Monate der Spontanverlauf unter konservativen Maßnahmen abgewartet werden. Das weitere Management wird weiterhin kontrovers diskutiert. Eine Steroidmonotherapie ist ineffektiv. Evidenzbasierte Strategien stellen die Gabe von Ciclosporin oder die Therapie nach Ponticelli-Schema (sequenzieller Einsatz von Steroiden mit Chlorambucil oder Cyclophosphamid) dar.

Abstract

Membranous nephropathy remains the most common cause of nephrotic syndrome in adults. The common variant is idiopathic membranous nephropathy with no evidence of any known precipitating factors. Membranous nephropathy also occurs as a secondary form in association with inflammatory or neoplastic diseases. Prognosis is mostly favorable as shown by the frequency of spontaneous remissions which averages 30%, although about one-third of patients progress to end-stage renal failure. Risk factors for a poor prognosis include severe proteinuria, hypertension, older age, male gender and impaired renal function. Therapy should include an ACE-Inhibitor and/or angiotensin-II receptor blocker to lower proteinuria (blood pressure ≤130/80 mmHg). The majority of patients should be observed for six months whilst receiving conservative treatment before deciding about an immunosuppressive approach. The debate over its management continues today. Steroids alone are ineffective. Evidence-based medicine supports the use of cyclosporine or the Ponticelli regimen (monthly cycling routine of chlorambucil or cyclophosphamide alternating with prednisone).

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Authors and Affiliations

  1. Medizinische Klinik IV, Zentrum für Innere Medizin, Universitätsklinikum Hamburg-Eppendorf

    S. Scheidat &  R. A. K. Stahl

  2. Medizinische Klinik IV, Zentrum für Innere Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg

    R. A. K. Stahl

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Correspondence to R. A. K. Stahl.

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Scheidat, S., Stahl, R.A.K. Membranöse Glomerulonephritis. Internist 44, 1120–1130 (2002). https://doi.org/10.1007/s00108-003-1022-5

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