Der Nephrologe

, Volume 7, Issue 1, pp 40–45

Klinisch relevante Faktoren der Progressionshemmung

Leitthema

Zusammenfassung

Neben der Aktivität der renalen Grunderkrankung spielen sekundäre hämodynamische und metabolische Faktoren für die Progression chronischer Nierenerkrankungen eine Rolle. Gesicherte und mögliche Faktoren umfassen Proteinurie, chronische Einnahme nephrotoxischer Medikamente, insbesondere potenziell nephrotoxischer Analgetika, Nikotinabusus, Hyperurikämie, metabolische Azidose sowie möglicherweise auch Phosphatretention und Vitamin-D-Mangel. Therapeutische Ansätze umfassen die Hemmung der Proteinurie mittels medikamentöser Maßnahmen und diätetischer Proteinrestriktion, die Senkung der Harnsäure, den Ausgleich der metabolischen Azidose, die Vermeidung nephrotoxischer Medikamente und die Nikotinkarenz. Kontrollierte Studien zeigen keinen Einfluss einer Lipidsenkung durch Statine oder Ausgleich der renalen Anämie auf die renale Progression.

Schlüsselwörter

Progression Proteinurie Hyperurikämie Metabolische Azidose Analgetikanephropathie 

Clinically relevant factors for inhibition of renal progression

Abstract

Progression of chronic renal disease results from the activity of the underlying renal disease and the presence of secondary hemodynamic and metabolic factors which may further impair renal function. Secondary factors comprise proteinuria, hyperuricemia, metabolic acidosis, long-term intake of nephrotoxic drugs, in particular potentially nephrotoxic analgesics, smoking and possibly phosphate retention and vitamin D deficiency. Therapeutic interventions include reduction of proteinuria by antihypertensive therapy and dietary protein restriction, lowering of uric acid, control of metabolic acidosis, cessation of smoking and avoidance of nephrotoxic drugs. Randomized controlled studies failed to show an influence of lipid lowering by statins and correction of renal anemia on renal progression.

Keywords

Progression Proteinuria Hyperuricemia Metabolic acidosis Analgesic nephropathy 

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Nephrologisches ZentrumSchwenningenDeutschland

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