Skip to main content
SpringerLink
Log in

Nephropathie und Hypertonie bei Typ-II-Diabetes

Nephropathy and Hypertension in Type II Diabetes

  • Übersicht
  • Published:
Medizinische Klinik Aims and scope Submit manuscript

Zusammenfassung

□ Hintergrund

Die Nephropathie des Typ-II-Diabetikers ist heute in Deutschland die häufigste Ursache einer der Nierenersatztherapie bedürftigen terminalen Niereninsuffizienz. Vor diesem Hintergrund kommt präventiven Maßnahmen große Bedeutung zu.

□ Diabetische Nephropathie und Hypertonie

Bei etablierter diabetischer Nephropathie ist die Hypertonie der wichtigste therapeutisch angehbare pathogenetische Faktor. Es werden daher einige für die Durchführung der antihypertensiven Therapie wichtige pathogenetischen Zusammenhänge dargestellt und die Beziehung zwischen Hypertonie und diabetischer Nephropathie analysiert.

□ Schlußfolgerung

Diabetische Nephropathie bei Typ-II-Diabetes ist derzeit die häufigste Ursache einer terminalen Niereninsuffizienz in Deutschland. Präventive Maßnahmen (normale Blutzuckereinstellung, vor allem jedoch antihypertensive Therapie) haben einen gesicherten hemmenden Effekt auf das Fortschreiten der Niereninsuffizienz bei diabetischer Nephropathie. Zur Früherkennung der diabetischen Nephropathie ist der Urinalbuminnachweis (Mikroalbuminurie) geeignet. Bei Patienten mit diabetischer Nephropathie ist die Senkung des Blutdrucks durch diätetische Kochsalzbeschränkung und medikamentöse antihypertensive Therapie in den mittleren normotensiven Bereich dringend indiziert.

Summary

□ Background

In Germany nephropathy in patients with type II diabetes has become the most frequent single cause of uremia requiring renal replacement therapy. This calls for effective measures of prevention

□ Diabetic Nephropathy and Hypertension

In patients with established diabetic nephropathy, hypertension is the most important pathogenetic factor which is susceptible to therapeutic intervention. Some pathogenetic mechanisms are discussed which impact on antihypertensive therapy. Interaction between hypertension and diabetic nephropathy is analyzed.

□ Conclusion

Diabetic nephropathy in patients with type II diabetes has become the most frequent cause of endstage renal failure in Germany. Preventive measures, i. e. near normal glycemia and particularly antihypertensive treatment, have been proven to interfere with progression of renal failure in diabetic nephropathy. Early recognition is possible by testing for urinary albumin (microalbuminuria). In patients with diabetic nephropathy, blood pressure should be lowered to values well within the range of normotension by dietary salt restriction and antihypertensive drug therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Annual Data Report: United States Renal Data System. US Department of Health and Human Services, Washington 1995.

    Google Scholar 

  2. Biesenbach, G., P. Janki, J. Zazgomik: Similar rate of progression in the predialysis phase in type I and type II diabetes mellitus. Nephrol. Dialys. Transplant. 9 (1994), 1097–1102.

    CAS  Google Scholar 

  3. Dieterle, P., H. Fehm, W. Stroder, J. Henner, P. Bottermann, K. Schwarz: Asymptomatischer Diabetes mellitus bei normalgewichtigen Hypertoniken. Dtsch. med. Wschr. 52 (1992), 2376–2381.

    Google Scholar 

  4. Dodson, P. M., M. Beevers, R. Hallworth, A. J. Webberley, R. F. Fletcher, K. G. Taylor: Sodium restriction and blood pressure in hypertensive type II diabetics: randomised blind controlled and crossover studies of moderate sodium restriction and sodium supplementation. Brit. med. J. 298 (1989), 227–230.

    Article  PubMed  CAS  Google Scholar 

  5. Drury, P. L., G. M. Smith, J. B. Ferriss: Increased vasopressin responsiveness to angiotensin II in type I (insulin-dependent) diabetic patients without complications. Diabetologia 27 (1984), 174–179.

    PubMed  CAS  Google Scholar 

  6. Fabre, J., L. P. Balant, P. G. Dayer, H. M. Fox, A. T. Vernet: The kidney in maturity onset diabetes mellitus: A clinical study of 150 patients. Kidney int. 21 (1982), 730–738.

    Article  PubMed  CAS  Google Scholar 

  7. Ferrannini, E., G. Buzzigoli, R. Bonadonna: Insulin resistance in essential hypertension. New engl. J. Med. 317 (1987), 350–356.

    PubMed  CAS  Google Scholar 

  8. Gall, M. A., P. Rossing, P. Skott, V. Damsbo, A. Vaag, K. Bech, A. Deigaard, M. Lauritzen, E. Lauritzen, P. Hougeard, H. Beck-Nielsen, H. H. Parving: Prevalence of micro- and macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European type 2 (non-insulin-dependent) diabetic patients. Diabetology 34 (1991), 655–661.

    Article  CAS  Google Scholar 

  9. Hasslacher, C., E. Ritz, P. Wahl, C. Michael: Similar risks of nephropathy in patients with type I or type II diabetes mellitus. Nephrol. Dialys. Transplant. 4 (1989), 859–863.

    CAS  Google Scholar 

  10. Hasslacher, C., G. Borholte, U. Panradl, P. Wahl: Verbesserte Prognose von Typ-I- und Typ-II-Diabetikern mit Nephropathie. Med. Klin. 85 (1990), 643–646.

    CAS  Google Scholar 

  11. Hasslacher, C., M. Wolfrum, G. Stech, P. Wahl, E. Ritz: Diabetische Nephropathie bei Typ-II-Diabetes. Dtsch. med. Wschr 112 (1987), 1445–1449.

    PubMed  CAS  Google Scholar 

  12. Jung, F. F., T. M. Kennefick, J. R. Ingelfinger, J. P. Vora, S. Anderson: Down-regulaton of the intrarenal renin-angiotensin system in the aging rat. J. Amer. Soc. Nephrol. 5 (1995), 1573–1580.

    CAS  Google Scholar 

  13. Keller, C. K., K. H. Bergis, D. Fliser, E. Ritz: Renal findings in patients with short term type 2 diabetes. J. Amer. Soc. Nephrol. (in press).

  14. Klahr, S.: The kidney in hypertension—villian and victim (editorial). New Engl. J. Med. 320 (1989), 731–733.

    PubMed  CAS  Google Scholar 

  15. Koch, M., W. Tschöpe, E. Ritz: Ist die Betreuung niereninsuffizienter Diabetiker in der prädialytischen Phase verbesserungsbedürftig? Dtsch. med. Wschr. 116 (1991), 1543–1548.

    PubMed  CAS  Google Scholar 

  16. Lippert, J., E. Ritz, A. Schwarzbeck, P. Schneider: The rising tide of endstage renal failure from diabetic nephropathy (type II)—an epidemiological analysis. Nephrol. Dialys. Transplant. 10 (1995), 462–467.

    CAS  Google Scholar 

  17. Mann, J., E. Ritz: Renin-Angiotensin-System beim diabetischen Patienten. Klin. Wschr. 66 (1988), 883–891.

    Article  PubMed  CAS  Google Scholar 

  18. Maranon, G.: Über Hypertonie und Zuckerkrankheit. Zbl. inn. Med. 43 (1922), 169.

    Google Scholar 

  19. Marcelli, D., D. Spotti, F. Conte, A. Limido, F. Lonati, F. Malberti, F. Locatelli: Prognosis of diabetic patients on dialysis: Analysis of Lombardy Registry data. Nephrol. Dialys. Transplant. 10 (1995), 1895–1901.

    CAS  Google Scholar 

  20. Michaelis, D., E. Jutzi: Epidemiologie des Diabetes mellitus in der Bevölkerung der ehemaligen DDR. Altersund geschlechtsspezifische Inzidenz- und Prävalenztrends im Zeitraum 1960–1987. Z. klin. Med. 46 (1991), 59–63.

    Google Scholar 

  21. Mogensen, C. E., W. F. Keane, P. H. Bennett, G. Jerums, H. H. Parving, P. Passa, M. W., Steffes, G. E. Striker, G. C. Viberti: Prevention of diabetic renal disease with special reference of microalbuminuria. Lancet 346 (1995), 1080–1084.

    Article  PubMed  CAS  Google Scholar 

  22. Nelson, R. G., D. J. Pettitt, H. R. Baird, M. A. Charles, Q. Z. Liu, P. H. Bennett, W. C. Knowler: Prediabetic blood pressure predicts urinary albumin secretion after the onset oftype 2 (noninsulin-dependent) diabetes mellitus in Pima Indians. Diabetologia 36 (1993), 998–1001.

    Article  PubMed  CAS  Google Scholar 

  23. Olivarius, N. F., A. H. Andreasen, N. Keiding, C. E. W., Mogensen: Epidemiology of renal involvement in newly diagnosed middle-aged and elderly diabetic patients. Cross-sectional data from the population-based study „Diabetes Care in General Practice”, Denmark. Diabetology 36 (1993), 1007–1016.

    Article  Google Scholar 

  24. Ordonez, J. D., R. A. Hiatt: Comparison of type II and type I diabetics treated for end-stage renal disease in a large prepaid health plan population. Nephron 51 (1989), 524–529.

    Article  PubMed  CAS  Google Scholar 

  25. Panzram, G., M. Marx, E. Frommhold, R. Barthel: Untersuchungen über Sterbealter, erlebtge Diabetesdauer und Todesursachen unter den Verstorbenen einer gescblossenen Diabetespopulation. Wien. klin. Wschr. 89 (1977), 147–150.

    PubMed  CAS  Google Scholar 

  26. Pietruck, F., S. Spleiter, A. Sell, A. Daul, T. Philipp, M. Derwahl, H. Schatz, W. Siffert: Enhanced G protein activation and susceptibility to nephropathy in insulin dependent diabetes mellitus (IDDM) (abstract). Nieren-u. Hochdruckkrh. 25 (1996), 444.

    Google Scholar 

  27. Pommer, W., F. Bressel, F. Chen, M. Molzahn: There is room for improvement of preterminal care in diabetic patients with endstage renal failure—The epidemiological evidence in Germany. Nephrol. Dialys. Transplant. (in press).

  28. Raine, A. E.: Epidemiology, development and treatment of endstage renal failure in type 2 (non-insulin-dependent) diabetic patients in Europe. Diabetologia 36 (1993), 1099–1104.

    Article  PubMed  CAS  Google Scholar 

  29. Ritz, E., A. Stefanski: Diabetic nephropathy in type II diabetes (indepth review). Amer. J. Kidney Dis. 27 (1996), 167–194.

    Article  CAS  Google Scholar 

  30. Ritz, E.: Epidemiologie und Klinik der diabetischen Nephropathie. Med. Klin. (im Druck).

  31. Rocchini, A. P., J. Key, D. Bondie: The effect of weight loss on the sensitivity of blood pressure to sodium in obese adolescents. New Engl. J. Med. 321 (1989), 580–585.

    PubMed  CAS  Google Scholar 

  32. Rodriguez, J. A., M. Cleries, E. Vela and Renal Registry Committee: Diabetic patients on renal replacement therapy: analysis of Catalan Registry Data, Nephrol. Dialys. Transplant. (in press).

  33. Schmidt, S., E. Ritz: The role of angiotensin I converting enzyme gene polymorphism in renal disease. Curr. Opin. Nephrol. Hypertens. 6 (1997), 146–151.

    Article  PubMed  CAS  Google Scholar 

  34. Siffert, W., R. Düsing: Sodium-proton exchange and primary hypertension. An Update. Hypertens. 26 (1995), 649–655.

    CAS  Google Scholar 

  35. Standl, E., H. Stiegler: Microalbumiauria in a random cohort of recently diagnosed type 2 (non-insulin-dependent) diabetic patients living in the greater Munich area. Diabetology 36 (1993), 1017–1020.

    Article  CAS  Google Scholar 

  36. Strojek, K., W. Grzeszczak, E. Morawin, M. Adamski, B. Lacka, H. Rudzki, S. Schmidt, C. Keller, E. Ritz: nephropathy of type II diabetes— evidence for hereditary factors? Kidney int. (in press).

  37. Strojek, K., W. Grzeszczak, B. Lacka, J. Gorska, C. K. Keller, E. Ritz: Increased prevalence of salt sensitity of blood pressure in IDDM with and without microalbuminuria. Diabetology 38 (1995), 1443–1448.

    Article  CAS  Google Scholar 

  38. Tuck, M. L., J. Sowers, L. Dornfeld, G. Kledzik, M. Maxwell: The effect of weight reduction on blood pressure, plasma renin activity and plasma aldosterone levels in obese patients. New Engl. J. Med. 304 (1981), 930–933.

    PubMed  CAS  Google Scholar 

  39. Weidmann, P., C. Beretta-Piccoli, G. Keusch, Z. Glück, M. Mujagie, M. Grimm, A. Meier, W. H. Ziegler: Sodium volume factor, cardiovascular reactivity and hypotensive mechanism of diuretic therapy, in mild hypertension associated with diabetes mellitus. Amer. J. Med. 67 (1979), 779–784.

    Article  PubMed  CAS  Google Scholar 

  40. Weidmann, P., C. Beretta-Piccoli, W. H. Ziegler, G. Keusch, Z. Glock, F. C. Reubi: Age versus urinary sodium for judging renin, aldosterone and catecholamine levels: Studies in normal subjects and patients with essential hypertension. Kidney int. 14 (1978), 619–628.

    Article  PubMed  CAS  Google Scholar 

  41. Weidmann, P., R. Reinhart, M. H. Maxwell, P. Rewe, J. W. Coburn, S. G. Massry: Syndrome of hyporeninemic hypoaldosteronism and hyperkalemia in renal disease. J. Endocr. Metab. 36 (1973), 965–977.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Universitätsklinik Heidelberg, Heidelberg, Deutschland

    Eberhard Ritz & Christine Keller

  2. Diabetesforschungszentrum Bad Mergentheim, Deutschland

    Kristian Bergis

  3. Silesian School of Medicine, Zabrze, Polen

    Krzysztof Strojek

  4. Sektion Nephrologie, Klinikum der Universität, Bergheimer Straße 56a, D-69115, Heidelberg, Deutschland

    Eberhard Ritz

Authors
  1. Eberhard Ritz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristian Bergis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Krzysztof Strojek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christine Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Herrn Professor Dr. Hans-Peter Schuster zum sechzigsten Geburtstag

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ritz, E., Bergis, K., Strojek, K. et al. Nephropathie und Hypertonie bei Typ-II-Diabetes. Med. Klin. 92, 421–425 (1997). https://doi.org/10.1007/BF03042574

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03042574

Schlüsselwörter

Key words

Search

Navigation