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Nierenmanifestationen bei rheumatoider Arthritis und Spondyloarthritiden

Renal manifestations in rheumatoid arthritis and spondylarthritis

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Journal für Mineralstoffwechsel & Muskuloskelettale Erkrankungen Aims and scope

Zusammenfassung

Entzündlich rheumatische Erkrankungen weisen als Systemerkrankungen nicht selten eine renale Beteiligung auf. Im Gegensatz zu den Kollagenosen und Vaskulitiden sind bei rheumatoider Arthritis und den Spondyloarthritiden direkte entzündliche Manifestationen im Sinne von Glomerulonephritiden (GN) und autoimmunen interstitiellen Nephritiden sehr selten. Nierenbiopsien zeigen in diesen Krankheitsgruppen GN vom Typ der mesangioproliferativen GN/Ig(Immunglobulin)A-Nephropathie oder seltener der membranösen GN. Diese und sekundäre AA(Amyloid A)-Amyloidosen sind regelmäßig mit länger anhaltender Krankheitsaktivität und schlechter Prognose assoziiert. Klinisch häufiger und relevanter sind aber andere Folgen der chronischen systemischen Inflammation, nämlich die endotheliale Funktionsstörung und vorzeitige Atheroskleroseentwicklung mit der Folge einer progredienten Niereninsuffizienz. Hinzu kommen unerwünschte Wirkungen antirheumatischer Therapien und renale Komplikationen von Komorbiditäten.

Abstract

As systemic diseases it is not uncommon for inflammatory rheumatic diseases to exhibit renal involvement. In contrast to connective tissue diseases and vasculitis, in rheumatoid arthritis and spondylarthritis direct inflammatory manifestations in the sense of glomerulonephritis (GN) and autoimmune interstitial nephritis are rare. In these groups of diseases renal biopsies usually show mesangial proliferative GN and IgA nephropathy or less commonly membranous GN. These and secondary amyloid A (AA) amyloidosis are regularly associated with longer lasting disease activity and a poor prognosis; however, clinically more frequent and more relevant are other sequelae of chronic systemic inflammation, namely endothelial function disorder and the premature development of atherosclerosis, resulting in progressive kidney failure. In addition, undesired effects of antirheumatic treatment and renal complications of comorbidities can occur in rheumatic diseases.

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Authors and Affiliations

  1. Klinik Innere Medizin IV (Rheumatologie, klinische Immunologie, Nephrologie), Helios Dr. Horst Schmidt Kliniken Wiesbaden GmbH, Ludwig Erhard Str. 100, 65199, Wiesbaden, Deutschland

    Elisabeth Märker-Hermann

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Correspondence to Elisabeth Märker-Hermann.

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Märker-Hermann, E. Nierenmanifestationen bei rheumatoider Arthritis und Spondyloarthritiden. J. Miner. Stoffwechs. Muskuloskelet. Erkrank. 30, 48–53 (2023). https://doi.org/10.1007/s41970-023-00237-w

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  • DOI: https://doi.org/10.1007/s41970-023-00237-w

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