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Die Nierenarterienstenose

Pathophysiologie – Diagnostik – Therapie

Renal Artery Stenosis. Pathophysiology – Diagnosis – Therapy

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Zusammenfassung

Die Prävalenz der Nierenarterienstenose (NAST) in der Altersgruppe > 65 Jahre wird in der Literatur mit 6,8% angegeben. Bei Patienten mit bekannter oder vermuteter Arteriosklerose, bei denen eine Darstellung der Nierenarterien im Rahmen einer Koronarangiographie durchgeführt wird, findet sich eine deutlich höhere Häufigkeit von 11–23%. Trotz dieser hohen Prävalenz sind die Indikationen zur Revaskularisation umstritten. Die Anzahl interventioneller Eingriffe an Nierenarterien hat zugenommen, obwohl bekannt ist, dass bis zu 40% der Patienten weder im Hinblick auf die arterielle Hypertonie noch im Hinblick auf die Nierenfunktion von diesem Eingriff profitieren. Diese Tatsache unterstreicht, dass bei der Therapieentscheidung sowohl morphologische als auch funktionelle Aspekte berücksichtigt werden müssen. Zur morphologischen Evaluation einer NAST stehen heute die Computertomographie, die Magnetresonanztomographie sowie als Goldstandard die Angiographie zur Verfügung. Als wichtigstes funktionelles Verfahren ist die Doppler-Sonographie zu nennen, aber auch die intravasale Druck- und Flussmessung stellen wichtige Methoden dar, deren prädiktive Wertigkeit im Hinblick auf den Langzeiterfolg einer Intervention jedoch noch untersucht werden muss. Obwohl die perkutane Revaskularisation einer NAST im Vergleich zum operativen Vorgehen mit einer deutlich geringeren Komplikationsrate einhergeht, muss immer berücksichtigt werden, dass durch die notwendige Kontrastmittelgabe auch eine Verschlechterung der Nierenfunktion verursacht werden kann und dass daher eine sorgfältige Indikationsstellung wichtig ist.

Abstract

Renal artery stenosis (RAS) is both a common and progressive disease and its prevalence in patients > 65 years is 6.8%. In patients with known or suspected atherosclerosis undergoing coronary angiography, a frequency of even 11–23% is reported in the literature. Despite this high prevalence, there is an ongoing discussion about the indications for revascularization and it is currently unclear, whether renal artery revascularization reduces adverse cardiovascular and renal events. Nevertheless, the number of interventions for RAS is rising steadily, although up to 40% of patients do not profit from this intervention. This fact underlines the necessity of a thorough diagnostic work-up before intervention, integrating morphological and functional tests. For morphological evaluation, multislice computed tomography, magnetic resonance tomography or digital subtraction angiography can be done. In experienced centers, Doppler ultrasound can serve as an excellent functional tool, to assess the physiological relevance of an RAS, but also invasive measurements of pressure and flow provide valuable information about the significance of stenoses; however, these methods will have to be assessed with respect to their value to predict long-term outcome. Although percutaneous intervention of RAS is associated with a substantially lower risk of major adverse events as compared to surgery, by using contrast media this procedure holds the risk of deterioration of renal function and of a small number of procedure-dependent complications as well. Thus, a careful consideration of pros and cons of this procedure is mandatory.

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Authors and Affiliations

  1. Klinik für Kardiologie, Westdeutsches Herzzentrum, Universitätsklinikum Essen, Essen, Germany

    Heinrich Wieneke, Thomas Friedrich Michael Konorza, Holger Eggebrecht, Sebastian Philipp & Raimund Erbel

  2. Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus Essen, Essen, Germany

    Christoph Kurt Naber

  3. Klinik für Nephrologie, Universitätsklinikum Essen, Essen, Germany

    Thomas Philipp & Andreas Kribben

  4. Klinik für Kardiologie, Westdeutsches Herzzentrum, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Germany

    Heinrich Wieneke

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  1. Heinrich Wieneke
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  2. Thomas Friedrich Michael Konorza
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Wieneke, H., Konorza, T.F.M., Eggebrecht, H. et al. Die Nierenarterienstenose. Med Klin 104, 349–355 (2009). https://doi.org/10.1007/s00063-009-1073-z

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  • DOI: https://doi.org/10.1007/s00063-009-1073-z

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