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Nierenmanifestationen bei rheumatischen Erkrankungen

Renal manifestations in rheumatic diseases

  • Schwerpunkt: Niereninsuffizienz
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Zusammenfassung

Entzündliche rheumatische Gelenkerkrankungen außerhalb von systemischen Vaskulitiden und Lupus erythematodes gehen häufig mit renalen Veränderungen einher, die wegen des meist schleichenden Verlaufes und der oft nur mäßigen Nierenfunktionseinschränkung klinisch weniger beachtet werden. Hierzu gehören vaskuläre, glomeruläre und tubulointerstitielle Veränderungen. Bei der rheumatoiden Arthritis ist die renale Manifestation prognostisch relevant. Die Nierenbeteiligung kann im Rahmen der AA-Amyloidose über das schwer behandelbare nephrotische Syndrom schleichend und bei der systemischen Sklerose im Sinne der sklerodermen renalen Krise in wenigen Tagen zur terminalen Niereninsuffizienz führen. Die differenzialdiagnostische Abgrenzung zu Nierenfunktionsstörungen bei interkurrenten Infekten oder durch die antiinflammatorische Medikation selbst ist wichtig.

Abstract

Inflammatory rheumatic diseases other than systemic vasculitides and systemic lupus erythematosus are frequently associated with renal abnormalities, which are clinically less apparent due to the subtle course and the often only moderate impairment of renal function. These abnormalities include vascular, glomerular and tubulointerstitial changes. Renal manifestations in the course of rheumatoid arthritis influence the prognosis of the disease. Renal involvement due to AA amyloidosis following long-standing inflammatory joint disease can lead slowly, over years, to end-stage renal disease. A scleroderma renal crisis in the course of systemic sclerosis can potentially result in end-stage renal disease within days. The differential diagnosis of renal abnormalities in a rheumatic patient should include drug induced renal impairment as well as infection.

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Danksagung

Herrn PD Dr. M. Mengel und Frau Dr. V. Bröcker, Institut für Pathologie der Medizinischen Hochschule Hannover, die die histologischen Bilder zur Verfügung gestellt haben, sei dafür sehr herzlich gedankt.

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  1. Med. Klinik III (Nephrologie, Hypertensiologie, Rheumatologie), Klinikum Offenbach GmbH, 63069, Offenbach, Deutschland

    K. de Groot

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  1. K. de Groot
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de Groot, K. Nierenmanifestationen bei rheumatischen Erkrankungen. Internist 48, 779–785 (2007). https://doi.org/10.1007/s00108-007-1887-9

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  • DOI: https://doi.org/10.1007/s00108-007-1887-9

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