Der Diabetologe

, 5:563

Nephropathie bei Diabetes mellitus

CME Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Eine Nephropathie bei Diabetespatienten ist die zweithäufigste Komplikation mit einer Prävalenz zwischen 20–50% in der ambulanten Praxispopulation. Im Vergleich zu Typ-1-Diabetes-Patienten mit der klassischen diabetischen Glomerulosklerose ist die Ursache der Nephropathie bei Typ-2-Diabetes heterogener und häufiger Folge einer hypertensiv-vaskulären oder immunologischen Nierenkrankheit. Zur Prognoseeinschätzung dient die Bestimmung der glomerulären Filtrationsrate (Formel-Clearance) und der Albumin-/Proteinurie. Beide Parameter sind mit kardiovaskulärer Morbidität und Mortalität assoziiert. Grundlage für die Progressionsminderung der Nephropathie ist die Behandlung der Risikofaktoren Hyperglykämie, arterielle Hypertonie und Hypercholesterinämie im Kontext eines veränderten Lebensstils. Im fortgeschrittenen Stadium der Nephropathie liegt der Therapiefokus auf den Sekundärkomplikationen der Niereninsuffizienz (Knochenstoffwechsel- und Säure-Basen-Störungen, Anämie, Malnutrition) und rechtzeitiger Vorbereitung einer Nierenersatztherapie. Diabetespatienten in allen Altersstufen profitieren von einer Nierentransplantation. Eine Option zur kombinierten Nieren-Pankreas-Transplantation besteht für jüngere Typ-1-Diabetes-Patienten. Diabetespatienten profitieren ebenfalls von einem multidisziplinären und multiprofessionalen Therapiekonzept, in dem Hausarzt, Diabetologe, Kardiologe und Nephrologe gemeinsam das individuelle Behandlungsziel festlegen. Zielwerte für wesentliche Behandlungsparameter im fortgeschrittenen Stadium der Niereninsuffizienz sind nur begrenzt evidenzbasiert.

Schlüsselwörter

Diabetes mellitus Nephropathie Diagnostik Therapie 

Nephropathy in diabetes mellitus

Abstract

Nephropathy in diabetics is the number two complication of this disease with a prevalence of 20%–50% in the German outpatient population. Compared to type 1 diabetes with the typical glomerular diabetic lesions, nephropathy in type 2 diabetes is heterogeneous and frequently the result of hypertensive/vascular or immunological disease. Glomerular filtration rate (formula clearance) and albuminuria/proteinuria are reliable prognostic factors, both associated with cardiovascular morbidity and mortality. Baseline therapy to ameliorate renal failure includes control of the risk factors hyperglycemia, hypertension, and hyperlipidemia together with lifestyle changes. The therapeutic focus in advanced disease stages includes secondary consequences of renal failure (bone disease, acid-base and electrolyte disturbances, anemia, malnutrition). Timely preparation for renal replacement therapy is mandatory. Diabetic patients of all ages benefit from renal transplantation; combined pancreas-kidney transplantation is an option for younger type 1 diabetics. The diabetic patient benefits most from a multidisciplinary and multiprofessional therapy approach with individual therapeutic goals provided by the general practitioner, diabetologist, cardiologist, and nephrologist. Therapeutic targets in advanced kidney disease are based on limited evidence.

Keywords

Diabetes mellitus Nephropathy Diagnosis Therapy 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Vivantes Humboldt-KlinikumKlinik für Innere Medizin – NephrologieBerlinDeutschland

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