Zusammenfassung
Die chronische Niereninsuffizienz ist eine häufige Erkrankung. Deutschlandweit sind etwa 2 Mio. Menschen betroffen. In der Regel verläuft die chronische Niereninsuffizienz progredient. Bei Erreichen des terminalen Stadiums werden Dialyse oder Nierentransplantation notwendig. Typischerweise bleibt die Erkrankung über lange Zeit still und vom Patienten unbemerkt. Das ist gefährlich, da die Niereninsuffizienz bereits in den frühen Stadien mit einer steigenden Morbidität und Mortalität einhergeht. Umso wichtiger sind das möglichst frühe Erkennen der Niereninsuffizienz in der ärztlichen Praxis und die Einleitung von Maßnahmen, die die Progredienz verlangsamen bzw. die Begleitrisiken verbessern. In den letzten Jahren gab es diesbezüglich einige neue Erkenntnisse und therapeutische Prinzipienänderungen. Daher möchten wir aus nephrologischer Perspektive einen aktuellen Leitfaden für die Behandlung der chronischen Niereninsuffizienz geben. Dabei diskutieren wir, welche Untersuchungen für den Allgemeinarzt diagnostisch sinnvoll sind und ab wann der Patient zum Nephrologen überwiesen werden sollte. Pragmatisch beleuchten wir, welche Möglichkeiten des Nierenfunktionserhalts zur Verfügung stehen und wie sich die Gefahr von Begleiterkrankungen minimieren lässt.
Abstract
Chronic kidney disease is common in the general population with an estimated prevalence of roughly 2 million in Germany. Typically, chronic kidney disease is progressive and in the terminal stage the patients require dialysis or kidney transplantation. In many cases the disease remains silent for a long time but early stages are already associated with increasing morbidity and mortality. Therefore early detection is very important. In recent years several new concepts have been introduced that might help to slow the progression of chronic kidney disease or improve the accompanying risks. Here, we want to provide a nephrologist’s perspective on the current guidelines for the treatment and prevention of chronic kidney disease. We summarize which diagnostic approaches are useful for general practitioners and we take a pragmatic look at the existing opportunities for combating renal functional decline. We also shed light on established measures to minimize the risk of comorbidities.
Literatur
Go AS et al (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351(13):1296–1305
Girndt M et al (2016) The prevalence of renal failure. Results from the German health interview and examination survey for adults, 2008–2011 (DEGS1). Dtsch Arztebl Int 113(6):85–91
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 3(1):150
National Kidney Foundation K‑DOQI (2002) Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39(2 Suppl 1):1–266
Vassalotti JA et al (2016) Practical approach to detection and management of chronic kidney disease for the primary care clinician. Am J Med 129(2):153–162 e7
Taler SJ et al (2013) KDOQI US commentary on the 2012 KDIGO clinical practice guideline for management of blood pressure in CKD. Am J Kidney Dis 62(2):201–213
James PA et al (2014) Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 311(5):507–520
Remuzzi G et al (2005) The role of renin-angiotensin-aldosterone system in the progression of chronic kidney disease. Kidney Int Suppl 99:57–65
Fried LF et al (2013) Combined angiotensin inhibition for the treatment of diabetic nephropathy. N Engl J Med 369(20):1892–1903
Investigators O et al (2008) Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 358(15):1547–1559
Bakris GL et al (2015) Effect of finerenone on albuminuria in patients with diabetic nephropathy: a randomized clinical trial. JAMA 314(9):884–894
Kidney NF (2012) KDOQI clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis 60(5):850–886
Wanner C et al (2016) Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. doi:10.1056/NEJMoa1515920
Shah SN et al (2009) Serum bicarbonate levels and the progression of kidney disease: a cohort study. Am J Kidney Dis 54(2):270–277
May RC, Kelly RA, Mitch WE (1987) Mechanisms for defects in muscle protein metabolism in rats with chronic uremia. Influence of metabolic acidosis. J Clin Invest 79(4):1099–1103
Lai S et al (2015) Effect of personalized dietary intervention on nutritional, metabolic and vascular indices in patients with chronic kidney disease. Eur Rev Med Pharmacol Sci 19(18):3351–3359
de Brito-Ashurst I et al (2009) Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol 20(9):2075–2084
Phisitkul S et al (2010) Amelioration of metabolic acidosis in patients with low GFR reduced kidney endothelin production and kidney injury, and better preserved GFR. Kidney Int 77(7):617–623
Susantitaphong P et al (2012) Short- and long-term effects of alkali therapy in chronic kidney disease: a systematic review. Am J Nephrol 35(6):540–547
Rodenbach KE et al (2015) Hyperuricemia and progression of CKD in children and adolescents: the chronic kidney disease in children (CKiD) cohort study. Am J Kidney Dis 66(6):984–992
Sircar D et al (2015) Efficacy of febuxostat for slowing the GFR decline in patients with CKD and asymptomatic hyperuricemia: a 6‑month, double-blind, randomized, placebo-controlled trial. Am J Kidney Dis 66(6):945–950
Jain N, Reilly RF (2014) Effects of dietary interventions on incidence and progression of CKD. Nat Rev Nephrol 10(12):712–724
Garneata L et al (2016) Ketoanalogue-supplemented vegetarian very low-protein diet and CKD progression. J Am Soc Nephrol 27. doi:10.1681/asn.2015040369
Ritz E, Koleganova N, Piecha G (2011) Is there an obesity-metabolic syndrome related glomerulopathy? Curr Opin Nephrol Hypertens 20(1):44–49
Hall ME et al (2016) Cigarette smoking and chronic kidney disease in African Americans in the Jackson Heart Study. J Am Heart Assoc. doi:10.1161/JAHA.116.003280
Stegmayr B, Lithner F (1987) Tobacco and end stage diabetic nephropathy. Br Med J (Clin Res Ed) 295(6598):581–582
Staplin N et al (2016) Smoking and adverse outcomes in patients with CKD: the study of heart and renal protection (SHARP). Am J Kidney Dis. doi:10.1053/j.ajkd.2016.02.052
Palevsky PM et al (2013) KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis 61(5):649–672
Yamamoto KT et al (2013) Dietary phosphorus is associated with greater left ventricular mass. Kidney Int 83(4):707–714
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
S. Fleig, M. Patecki und R. Schmitt geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
Additional information
Redaktion
H. Haller, Hannover
Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/s00108-017-0238-8 zu finden.
Rights and permissions
About this article
Cite this article
Fleig, S., Patecki, M. & Schmitt, R. Chronische Niereninsuffizienz. Internist 57, 1164–1171 (2016). https://doi.org/10.1007/s00108-016-0150-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00108-016-0150-7