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01.03.2023 | Niereninsuffizienz | Innere Medizin

Nephrologisches Management und Medikamentendosierung bei Rheumapatienten mit Niereninsuffizienz

verfasst von: Prof. Dr. med. Stefan M. Weiner

Erschienen in: Wiener klinisches Magazin

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Zusammenfassung

Hintergrund

Bei Patienten mit entzündlich rheumatischen Erkrankungen und Niereninsuffizienz ergeben sich für den Therapeuten zwei Herausforderungen: die Rheumatherapie an die Nierenfunktion anzupassen und eine nephroprotektive Behandlung durchzuführen, die eine langfristige Verschlechterung der Nierenfunktion verhindert und das erhöhte kardiovaskuläre Risiko reduziert.

Methoden

Mittels Literaturrecherche (PubMed) wurde der aktuelle Wissensstand zur nephroprotektiven Therapie und zur Therapie rheumatischer Erkrankungen bei Niereninsuffizienz erhoben, bewertet und zusammengefasst.

Ergebnisse

Lifestyle-Interventionen, insbesondere die Beendigung eines Nikotinkonsums, und medikamentöse Therapieansätze bilden die Grundlage der Nephroprotektion inklusive Kontrolle des Diabetes mellitus mit Metformin, SGLT2(„sodium glucose transporter 2“)-Inhibitoren, GLP1(„glucagon-like peptide 1“)-Analoga, des Bluthochdrucks mit RAAS(„renin-angiotensin-aldosterone system“)-Blockade, der Hyperlipidämie, der Hyperphosphatämie und metabolischen Azidose. SGLT2-Inhibitoren sind auch bei nichtdiabetischer Nephropathie wirksam. Das erhöhte kardiovaskuläre Risiko wird mittels effektiver Kontrolle der Rheumaaktivität weiter gesenkt. Zahlreiche konventionelle Basismedikamente, insbesondere Methotrexat und die JAK(Januskinase)-Inhibitoren Baricitinib und Filgotinib müssen an die Nierenfunktion meist angepasst werden, während unter den Biologika dies nur für Anakinra der Fall ist. Das erhöhte kardiovaskuläre Risiko bei Niereninsuffizienz limitiert derzeit den Einsatz von Tofacitinib.

Schlussfolgerung

Patienten mit rheumatischen Erkrankungen und Niereninsuffizienz bedürfen einer Anpassung der medikamentösen Therapie und eines komplexen nephroprotektiven Behandlungskonzepts, das im optimalen Fall durch eine enge interdisziplinäre Zusammenarbeit von internistischen Rheumatologen und Nephrologen gewährleisten werden kann.

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Titel: Nephrologisches Management und Medikamentendosierung bei Rheumapatienten mit Niereninsuffizienz
verfasst von: Prof. Dr. med. Stefan M. Weiner
Publikationsdatum: 01.03.2023
Verlag: Springer Vienna
Schlagwörter: Niereninsuffizienz
Niere
Erschienen in: Wiener klinisches Magazin
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI: https://doi.org/10.1007/s00740-023-00485-0