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Wann sollte bei Patienten mit Diabetes mellitus eine Nierenbiopsie erfolgen?

When should a kidney biopsy be carried out in patients with diabetes mellitus?

  • Leitthema
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Der Nephrologe Aims and scope

Zusammenfassung

Hintergrund

Aufgrund der oft limitierten therapeutischen Konsequenzen wird die Bedeutung der Nierenbiopsie bei nierenkranken Diabetikern kontrovers diskutiert.

Fragestellung

Es soll eine aktuelle Übersicht zur Nierenbiopsieindikation bei Patienten mit Diabetes mellitus gegeben werden.

Methoden

Es erfolgte eine selektive Literaturrecherche sowie die Berücksichtigung eigener klinischer Erfahrungen an einem universitären nephrologischen Zentrum.

Ergebnisse

Der Verdacht auf nichtdiabetische Nierenerkrankungen stellt eine vornehmliche Biopsieindikation dar und kann bei Bestätigung die renale Prognose günstig beeinflussen. Als anerkannte Biopsieindikationen gelten das Vorliegen eines aktiven Urinsediments, eine nephrotische Proteinurie (>3,5 g/Tag), ein rascher Abfall der glomerulären Filtrationsrate (GFR) oder der Verdacht auf eine Systemerkrankung. Eine Diskrepanz zwischen Dauer und Schwere des Diabetes sowie dem Ausmaß der Nierenerkrankung ist suspekt. Die häufigsten nichtdiabetischen Nierenerkrankungen bei Diabetikern sind IgA-Nephritis, membranöse Glomerulonephritis, akute interstitielle Nephritis sowie fokal-segmentale Glomerulosklerose. Die normoalbuminurische Verlaufsform der diabetischen Nierenerkrankung ist heutzutage akzeptiert.

Schlussfolgerung

Bei Patienten mit Diabetes mellitus ist die Nierenbiopsie sowohl zur Abgrenzung nichtdiabetischer Nierenerkrankungen als auch zur (frühzeitigen) Diagnose und Prognoseabschätzung einer diabetischen Nephropathie von Bedeutung.

Abstract

Background

The diagnostic benefit of a kidney biopsy in patients with diabetes mellitus and kidney disease is controversially discussed. Moreover, the therapeutic consequences are limited in most cases.

Objectives

This article gives an update on the indications for renal biopsy in patients with diabetes mellitus.

Methods

A selective literature search was carried out and own clinical experiences at a university nephrology center were taken into account.

Results

Suspicion of non-diabetic kidney disease represents a primary indication for a kidney biopsy in patients with diabetes mellitus. The diagnosis of non-diabetic kidney disease can improve renal prognosis. Recognized indications for a biopsy are the presence of glomerular hematuria, nephrotic proteinuria (>3.5 g/day), a rapid decrease in the glomerular filtration rate (GFR) and suspected systemic disease. A discrepancy between the duration and severity of diabetic disease and the extent of kidney disease is suspicious. The most common non-diabetic renal diseases in patients with diabetes are IgA nephropathy, membranous glomerulonephritis, acute interstitial nephritis and focal segmental glomerulosclerosis. Nowadays, the normoalbuminuric type of diabetic nephropathy is accepted.

Conclusion

In patients with diabetes mellitus a renal biopsy is important for the diagnosis of non-diabetic kidney disease as well as for (early) diagnosis and prognosis assessment of diabetic nephropathy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Busch und G. Wolf geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Innere Medizin III, Klinikum der Friedrich-Schiller-Universität Jena, Erlanger Allee 101, 07747, Jena, Deutschland

    M. Busch & G. Wolf

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  1. M. Busch
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  2. G. Wolf
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Correspondence to M. Busch.

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Busch, M., Wolf, G. Wann sollte bei Patienten mit Diabetes mellitus eine Nierenbiopsie erfolgen?. Nephrologe 10, 271–278 (2015). https://doi.org/10.1007/s11560-014-0953-2

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