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Pathophysiologie und Therapie der IgA-Nephropathie

Arzneimitteltherapie
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Zusammenfassung

Die Immunglobulin-A(IgA)-Nephropathie ist weltweit die häufigste Form der Glomerulonephritiden. Bei ungefähr 30 % der Patienten wird innerhalb von 10 Jahren eine Reduktion der glomerulären Filtrationsrate um 50 % beobachtet. Bei Patienten mit IgA-Nephropathie findet sich die Bildung eines Immunglobulin-G(IgG)-Autoantikörpers gegen galaktosedefiziente IgA1-Antikörper. Es kommt zur Ablagerung dieser Antikörper im Mesangium und Aktivierung von Komplement mit mesangialer Hyperzellularität, endokapillärer Hyperzellularität, segmentaler Glomerulosklerose und atrophierender interstitieller Fibrose. Die Basistherapie für Patienten mit IgA-Nephropathie besteht in der Beseitigung der Risikofaktoren, insbesondere der Hypertonie mit Blockade des Renin-Angiotensin-Aldosteron-Systems. In verschiedenen Studien wurden auch Immunsuppressiva untersucht. Ein eindeutiger Vorteil der Immunsuppression wurde allerdings nicht beobachtet.

Schlüsselwörter

Autoimmunkrankheiten Glomerulonephritis Immunsuppressive Therapie Hypertonie Renin-Angiotensin-Aldosteron-System 

Pathophysiology and treatment of IgA nephropathy

Abstract

The IgA nephropathy is the most frequent form of glomerulonephritis worldwide. In approximately 30% of patients a reduction in the glomerular filtration rate of approximately 50% is observed within 10 years. Patients with IgA nephropathy form IgG autoantibodies against galactose-deficient IgA1 antibodies. This results in deposition of these antibodies in the mesangium and activation of complement with mesangial hypercellularity, endocapillary hypercellularity, segmental glomerulosclerosis and atrophying interstitial fibrosis. The basic treatment for patients with IgA nephropathy consists of removing risk factors, in particular hypertension, with blockade of the renin-angiotensin-aldosterone system. Immunosuppressives were also investigated in various studies but a clear advantage was not observed.

Keywords

Autoimmune diseases Glomerulonephritis Immunosuppression Hypertension Renin-angiotensin system 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

R. Bollin und H. Haller geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Nieren- und HochdruckerkrankungenMedizinische Hochschule HannoverHannoverDeutschland

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