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Sarkoidose

Renale Manifestationen

Sarcoidosis

Renal manifestations

  • Leitthema
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Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Renale Beteiligungen der Sarkoidose sind wesentlich häufiger als in alten epidemiologischen Studien angenommen. Sie verursachen jedoch in den meisten Fällen wenige Symptome und fallen erst bei gezielter Diagnostik auf. Im Rahmen eines kompletten Organstagings bei Sarkoidose sollte eine gezielte Diagnostik in Richtung einer möglichen Nierenbeteiligung nicht fehlen. Bei Hinweisen für eine Nierenbeteiligung in der Labordiagnostik wie Proteinurie, auffälligem Urinsediment oder einer eingeschränkter Nierenfunktion sollte zur Klärung der Art, Schwere und der Prognose der renalen Sarkoidose großzügig die Indikation zur Nierenbiopsie gestellt werden. Die Therapie stützt sich in erster Linie auf die Gabe von Kortikosteroiden. Zur Einsparung von Steroiden können immunsuppressive Basistherapeutika und Infliximab eingesetzt werden. Die Evidenz für diese Therapien beruht jedoch weitgehend auf dem Level von Fallberichten und Expertenmeinungen. Nach Absetzen der Immunsuppression besteht ein hohes Risiko für Rezidive.

Abstract

Renal involvement in sarcoidosis is much more common than generally assumed from old epidemiological studies and is often only detected when actively searched for. Many patients with renal sarcoidosis present with no or only few symptoms. The diagnostic work-up of sarcoidosis should always include a possible renal involvement. In cases of impaired renal function, proteinuria or a pathological urine sediment, a renal biopsy specimen should be obtained to assess the type, severity and prognosis of the kidney disease. Treatment is primarily based on the use of corticosteroids. Steroid-sparing agents, such as disease-modifying antirheumatic drugs and infliximab can be applied; however, the evidence for efficacy of these therapies is mostly based on case series and expert opinions. Discontinuation of immunosuppression therapy bears a high risk of relapse.

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Authors and Affiliations

  1. V. Medizinische Klinik, Nephrologie, Endokrinologie, Rheumatologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    C. Löffler

  2. Medizinische Klinik A, Hämatoonkologie, Nephrologie, Rheumatologie, Klinikum Ludwigshafen, Bremserstr. 79, 67069, Ludwigshafen, Deutschland

    R. Bergner

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Correspondence to C. Löffler.

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Interessenkonflikt

C. Löffler und R. Bergner geben an, dass kein Interessenkonflikt besteht.

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

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P. Korsten, Göttingen

R. Bergner, Ludwigshafen

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Löffler, C., Bergner, R. Sarkoidose. Z Rheumatol 76, 398–407 (2017). https://doi.org/10.1007/s00393-017-0301-9

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