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Renale Manifestationen rheumatischer Erkrankungen

Renal manifestations of rheumatic diseases

  • BEITRAG ZUM SCHWERPUNKTTHEMA
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Zusammenfassung

Entzündlich-rheumatische Erkrankungen weisen im Verlauf nicht selten subklinische oder auch klinisch relevante Nierenmanifestationen auf. Dies gilt im Besonderen für die Systemerkrankungen, also Kollagenosen und Vaskulitiden, bei denen ein renaler Befall Prognose- und Therapie-entscheidend sein kann. Weniger bekannt sind die häufig schleichend verlaufenden renalen Beteiligungen der rheumatoiden Arthritis und der Spondyloarthritiden. Langjährig entzündlich aktive rheumatische Erkrankungen können zudem durch sekundäre AA-Amyloidosen mit renaler Manifestation kompliziert werden. Klinisch gilt es, die glomerulären (nephritisches und nephrotisches Syndrom, rapid-progrediente Nephritis) von den tubulo-interstitiellen Syndromen zu unterscheiden. Im Einzelfall stellt sich bei Nierenfunktionsstörungen die Differentialdiagnose zu Rheuma-unabhängigen Nierenerkrankungen, zu Infektionen und zu medikamentös bedingten glomerulären und tubulo-interstitiellen Nierenschäden.

Summary

Inflammatory rheumatic diseases are frequently complicated by subclinical or overt renal manifestations. This is well known for the connective tissue diseases and vasculitides in which renal disease can be of significant prognostic value and therapeutic implication. However, rheumatoid arthritis and the spondyloarthritides can also be associated with direct renal manifestation or with secondary renal AA-amyloidosis. The clinician should be aware of the different glomerular (i. e. nephritic or nephritic syndrome, rapidly progressive renal disease) and tubulo-interstitial syndromes. In any case of renal dysfunction in a rheumatic patient, the differential diagnosis should include renal disease independent from the rheumatic condition, infection, and drug-induced renal toxicity.

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Authors and Affiliations

  1. I. Medizinische Klinik und Poliklinik der Johannes-Gutenberg-Universität, 55101, Mainz, Germany

    A. Schwarting

  2. Klinik Innere Medizin IV, HSK Dr.-Horst-Schmidt-Kliniken GmbH, Aukammallee 39, 65191, Wiesbaden, Germany

    E. Märker-Hermann

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  1. A. Schwarting
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Correspondence to A. Schwarting.

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Schwarting, A., Märker-Hermann, E. Renale Manifestationen rheumatischer Erkrankungen. Z. Rheumatol. 64, 18–25 (2005). https://doi.org/10.1007/s00393-005-0700-1

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