Chronische Niereninsuffizienz

  • Christine K. Keller
  • Steffen K. Geberth


Der natürliche Verlauf der chronischen Niereninsuffizienz ist progredient. Diese Progredienz wird unabhängig von der Grunderkrankung von sekundären Faktoren beeinflusst. Als wichtigste Progressionsfaktoren betrachtet man die intraglomeruläre Hypertonie und die glomeruläre Hypertrophie. Diese sind für die adaptive Hyperfiltration und später für die Glomerulosklerose verantwortlich. Einfluss auf die Geschwindigkeit des Nierenfunktionsverlustes haben außerdem intraglomeruläre Lipid- und Kalziumphosphatablagerungen, tubulointerstitielle und hyperglykämiebedingte Schäden und die metabolische Azidose.


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  1. Alpern RJ, Sakhaee K (1997) The clinical spectrum of chronic metabolic acidosis: homeostatic mechanisms produce significant morbidity. Am J Kidney Dis 29:291–302CrossRefPubMedGoogle Scholar
  2. American Diabetes Association.Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Position statement. Diabetes Care 2002; 25(1): 202–212CrossRefGoogle Scholar
  3. Antonsen JE, Sherrard DJ, Andress DL (1998) A cacimimetic agent acutely suppresses parathyroid hormone levels in paitens with chronic renal failure. Kidney Int 53: 22–27CrossRefGoogle Scholar
  4. Berlinger WG, Park GD, Spector R (1985) The effect of dietary protein on the clearance of allopurinol and oxypurinol. N Engl J Med 313:771–776CrossRefPubMedGoogle Scholar
  5. Bolton CF, Young GB (1990) Uremic neuropathy. In: Neurologic complications of renal disease. Butterworth, Boston, S. 76–107Google Scholar
  6. Brater CK (1996) Manual of Drug Use in Clinical Medicine, 7th ed, Improved Therapeutics, IndianapolisGoogle Scholar
  7. Chrysostomou, A, Pedagogos, E, MacGregor, L, Becker (2006) GJ. Double-blind, placebo controlled study on the effect of aldosterone receptor antagonist spironolactone in patients who have persistent proteinuria and are on longterm angiotensin-converting enzyme inhibitor therapy, with or without an angiotensin ii receptor blocker. Clin J Am Soc Nephrol 2006; 1:256CrossRefGoogle Scholar
  8. De Jong PE, Anderson S, de Zeeuw D (1993) Glomerular preload and afterload reduction as a tool to lower urinary protein leakage: will such treatments also help to improve renal function outcome? [editorial] J Am Soc Nephrol 3:1333–1341PubMedGoogle Scholar
  9. Delmez JA, Slatopolsky E (1992) Hyperphosphatemia: Its consequences and treatment in chronic renal failure. Am J Kidney Dis 19:303–310PubMedGoogle Scholar
  10. Eberst ME, Berkowith LR (1994) Hemostasis in renal disease: Pathophysiologiy and management. Am J Med 96: 168–176CrossRefPubMedGoogle Scholar
  11. Fletcher S, Kanagasundaram NS, Rayner HC et al. (1998) Assessment of ultrasound guided percutaneous ethanol injection and parathyroidectomy in patients with tertieary hyperparathyroidism. Nephrol Dial Transplant: 13: 3111–3118CrossRefPubMedGoogle Scholar
  12. Gansevoort RT, Sluiter WJ, Hemmelder MH, de Zeeuw D, de Jong PE (1995) Antiproteinuric effect of blood-pressurelowering agents: a meta-analysis of comparative trials. Nephrol Dial Transplant 10:1963–1974PubMedGoogle Scholar
  13. Hunsicker LG, Adler S, Caggiula A, England BK, Greene T, Kusek JW, Rogers NL, Teschan PE (1997) Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int. Jun;51(6):1908–19.CrossRefPubMedGoogle Scholar
  14. Hsu CH, Patel SR, Young EW, Vanholder R (1994) The biological action of calcitriol in renal failure. Kidney Int 46: 605–611CrossRefPubMedGoogle Scholar
  15. Ikizler TA, Greene JH, Wingard RL, Parker RA, Hakim RM (1995) Spontaneous dietary protein intake during progression of chronic renal failure. J Am Soc Nephrol Nov;6(5):1386–1391Google Scholar
  16. Jacobson HR; Striker GE (1995) Report on a workshop to develop management recommendations for the prevention of progression in chronic renal disease. Am J Kidney Dis 25: 103–106CrossRefPubMedGoogle Scholar
  17. Kasiske BL, Lakatua JD, Ma JZ, Louis TA (1998) A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function [see comments] Am J Kidney Dis 31: 954–961Google Scholar
  18. Khanna R, Leibel B (1981)The Toronto Western Hospital Protocol. Perit Dial Bull 1: 101–110Google Scholar
  19. Kent RB, Lylerly RT (1994) systemic calciphylaxis. South Med J 87: 278–283CrossRefPubMedGoogle Scholar
  20. King AJ, Levey AS (1993) Dietary protein and renal function [editorial] J Am Soc Nephrol 3:1723–1737Google Scholar
  21. Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, Striker G (1994) The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group [see comments] N Engl J Med 330: 877–884Google Scholar
  22. Levey AS, Greene T, Beck GJ, Caggiula AW, Kusek JW, Hunsicker LG, Klahr S (1999) Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study group. J Am Soc Nephrol 10: 2426–2439PubMedGoogle Scholar
  23. Levey et al (2003) National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Int Med 139,137PubMedGoogle Scholar
  24. Levey et al (2005) Definition and classification of chronic kidney disease, a position statement from Kidney Disease, Improving Global Outcomes (KDIGO). Kidney Int 67. 2089CrossRefPubMedGoogle Scholar
  25. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD (1993) The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group N Engl J Med 329:1456–1462Google Scholar
  26. Mak RH, DeFronzo RA (1992) Glukose and insulin metabolism in uremia. Nephron 61: 377–382CrossRefPubMedGoogle Scholar
  27. Martin KH, Gonzalez E, Gellens M et al (1998) 19-Nor-1-alpha- 25-Dihydroxyvitamin D2 (Paricalcitol) safely and effectively reduces the levels of intact parathyroid hormone in patients on hemodialysis. J Am Soc Nephrol 9: 1427–1432PubMedGoogle Scholar
  28. Meyer TW, Anderson S, Rennke HG, Brenner BM (1987) Reversing glomerular hypertension stabilizes established glomerular injury. Kidney Int 31: 752–759CrossRefPubMedGoogle Scholar
  29. Mogensen CE, Neldam S, Tikkanen I et al. (2000) Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 321: 1440–1444CrossRefPubMedGoogle Scholar
  30. Movilli E, Zani R, Carli O et al. (1998) Correction of metabolic acidosis increases serum albumin concentrations and decreases kinetically evaluated protein intake in haemodialysis patients: a prospective study.Nephrol Dial Transplant 13(7):1719–1722CrossRefPubMedGoogle Scholar
  31. Mucsi I, Hercz G (1998) Control of serum phosphate in patients with renal failure – New approaches. Nephrol Dial Transplant 13:2457–2462CrossRefPubMedGoogle Scholar
  32. Nath KA, Hostetter MK, Hostetter TH (1985) Pathophysiology of chronic tubulo-interstitial disease in rats. Interactions of dietary acid load, ammonia, and complement component C3. J Clin Invest 76(2):667–675CrossRefPubMedGoogle Scholar
  33. NKF (2002) K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease, Am J Kidney Dis 39: S46-S64CrossRefGoogle Scholar
  34. Reese GN, Appel SH (1981) Neurologic comnplications of renal failure. Semin Nephrol 1: 137–150Google Scholar
  35. Reichel H, Szabo A, Uhl J et al. (1993) Intermittent versus contiuous administration of 1,25-dihydroxyvitamin D3 in experimental hyperparathyroidism. Kidney Int 44:1259–1264CrossRefPubMedGoogle Scholar
  36. Rostand SG, Rutsky EA (1990) Pericarditis in end-stage renal disease. Cardiol Clin 8: 701–706PubMedGoogle Scholar
  37. Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G (Gruppo Italiano di Studi Epidemiologici in Nefrologia GISEN) (1998) Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Ramipril Efficacy in Nephropathy. Lancet 352:1252–1256CrossRefPubMedGoogle Scholar
  38. Ruggenenti P, Perna A, Mosconi L, Pisoni R, Remuzzi G. (1998) Urinary protein excretion rate is the best independent predictor of ESRF in non-diabetic proteinuric chronic nephropathies. »Gruppo Italiano di Studi Epidemiologici in Nefrologia« (GISEN). Kidney Int. May;53(5):1209–16.CrossRefPubMedGoogle Scholar
  39. Ruska KA, Teitelbaum SL (1995) Mechanisms of disease: Renal osteodystrophy. N Engl J Med: 333: 166–173CrossRefGoogle Scholar
  40. Salem MM (1997) Hyperparathyroidism in the hemodialysis population: A survey of 612 patients. Am J Kidney Dis: 29: 862–866CrossRefPubMedGoogle Scholar
  41. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia) (1997) Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. [see comments] Lancet 349:1857–1863CrossRefGoogle Scholar
  42. Tzamaloukas AH (1994) Diabetes. In: Daugirdas JT, Ing TS (Eds) Handbook of Dialysis, 2nd ed Little, Brown, Boston, S: 422–432Google Scholar
  43. Walser M, Hill S, Tomalis EA (1996) Treatment of nephrotic adults with a supplemented, very low-protein diet. Am J Kidney Dis 28:354–364CrossRefPubMedGoogle Scholar
  44. Wright JT, Bakris G, Greene T et al. (2002) Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease. Results from the AASK trial. JAMA; 288: 2421–2431CrossRefPubMedGoogle Scholar
  45. Zucchelli P, Zuccala A, Borghi M, Fusaroli M, Sasdelli M, Stallone C, Sanna G, Gaggi R (1992) Long-term comparison between captopril and nifedipine in the progression of renal insufficiency. Kidney Int 42:452–458CrossRefPubMedGoogle Scholar
  46. Zurcher G (2002) Diatetische Prophylaxe und Therapie der chronischen Niereninsuffizienz, 3. Wissenschaftliche Tagung des Bundesverbandes Deutscher Ernahrungsmediziner, Abstract, MunsterGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Christine K. Keller
    • 1
  • Steffen K. Geberth
    • 2
  1. 1.Gemeinschaftspraxis für Diabetes und Nierenerkrankungen Dialysezentrum GrünstadtGrünstadt
  2. 2.Praxis für Nieren- und Hochdruckerkrankungen Dialysezentrum WieblingenHeidelberg

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