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Metabolische Kontrolle bei diabetischer Nephropathie

Metabolic control in diabetic nephropathy

  • Leitthema
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Zusammenfassung

Der Verlauf der diabetischen Nephropathie kann in allen Stadien durch eine gute Stoffwechsel- und Blutdruckeinstellung entscheidend beeinflusst werden. Dies ist bei eingeschränkter Nierenfunktion in der praktischen Umsetzung jedoch nicht einfach. Zunächst muss die Niereninsuffizienz erkannt werden, damit unter Berücksichtigung der veränderten Pharmakokinetik die blutzuckersenkenden Substanzen angepasst werden können. Orale Antidiabetika, die über die Niere eliminiert werden, sind bei Nephropathie kontraindiziert. Aber auch beim Abbau in der Leber können Metaboliten gebildet werden, die renal ausgeschieden werden, was gegen die Anwendung der entsprechenden Substanzen bei Nephropathie spricht. In der Insulintherapie spielen die Änderung der Insulinresistenzlage, des Insulinabbaus sowie die Störung der Gegenregulation bei Hypoglykämien eine entscheidende Rolle. Um eine gute Stoffwechseleinstellung zur Nephroprotektion auch bei nachlassender Nierenfunktion zu erreichen, sollte frühzeitig auf eine Insulintherapie umgestellt werden.

Abstract

Throughout the course of diabetic nephropathy, well adjusted metabolism and blood pressure can play a critical role. In the case of reduced renal function, this is not easy to achieve. First, renal insufficiency must be recognised in order to take into consideration the changed pharmacokinetics in adjusting blood sugar regulatory substances. Oral antidiabetics which are eliminated via the kidneys are contraindicated in cases of nephropathy as are drugs whose metabolites, produced in the liver, are eliminated by the kidneys. Changes in the resistance to insulin and insulin degradation, leading to a reduced half-life as well as disturbance to counter regulation by hypoglycemia, play a role in the treatment of renal insufficiency. For good metabolic adjustment for protection of the kidneys, also by reduced renal function, conversion to early insulin therapy should be made.

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  1. Abteilung Innere Medizin, St. Josefskrankenhaus, Heidelberg, Akademisches Lehrkrankenhaus der Universität Heidelberg, Landhausstraße 25, 69115, Heidelberg, Deutschland

    C. Hasslacher

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Hasslacher, C. Metabolische Kontrolle bei diabetischer Nephropathie. Diabetologe 2, 410–418 (2006). https://doi.org/10.1007/s11428-006-0074-2

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