Zusammenfassung
Das nephrotische Syndrom beschreibt einen Symptomkomplex aus Proteinurie von mehr als 3,5 g/24 h, Hypalbuminämie, Hyperlipidämie und Ödemen. Dem nephrotischen Syndrom liegt immer eine Schädigung der Podozyten zugrunde, welche zu etwa 70% von primären Glomerulonephritiden (membranöse Nephropathie, fokal-segmentale Glomerulosklerose, Minimal-Change-Erkrankung etc.) und zu ca. 30% von Systemerkrankungen (Diabetes mellitus, systemischer Lupus erythematodes, Amylodiose etc.) verursacht wird. Trotz der unterschiedlichen spezifischen Therapien für die jeweiligen Grunderkrankungen gelten für die symptomatische und supportive Therapie gemeinsame Therapiestrategien. Unter der symptomatischen Therapie subsumiert man u. a. die Gabe von ACE-Hemmern oder Angiotensinrezeptorblockern zur Senkung der Proteinurie und zur Blutdruckkontrolle, das Ausschwemmen der Ödeme mit Schleifendiuretika, eine kochsalzarme Diät, eine Statintherapie, prophylaktische Impfungen und ggf. die orale Antikoagulation bei hohem Thromboserisiko.
Abstract
Nephrotic syndrome describes a group of symptoms including proteinuria of >3.5 g/24 h, hypoalbuminemia, hyperlipidemia and edema. Underlying diseases result in podocyte injury and can be subdivided into primary glomerulopathies, such as membranous nephropathy, focal segment glomerular sclerosis (FSGS) and minimal change disease, and systemic diseases, such as diabetes mellitus, systemic lupus erythematosus and amyloidosis. Despite the different specific forms of therapy for each underlying disease, the symptomatic and supportive care follows a common therapeutic strategy. The symptomatic treatment includes the administration of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) to reduce proteinuria and to control blood pressure, diuretic therapy, low sodium diet, statin therapy, vaccinations and anticoagulation in case of high thrombosis risk.
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Keil, A., Huber, T. Nephrotisches Syndrom bei Erwachsenen. Nephrologe 8, 156–164 (2013). https://doi.org/10.1007/s11560-012-0692-1
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DOI: https://doi.org/10.1007/s11560-012-0692-1