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Medikamentöse oder instrumentelle Therapie der Nierenarterienstenose?

Medicinal or surgical therapy of renal artery stenosis?

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An Erratum to this article was published on 26 May 2012

Zusammenfassung

Die arteriosklerotische Nierenarterienstenose (NAST) hat eine erhöhte Inzidenz bei Patienten mit kardiovaskulären Risikofaktoren. Klinisch präsentiert sich die NAST bei manchen Patienten als sekundäre, teils schwer einstellbare arterielle Hypertonie, bei anderen als chronische Niereninsuffizienz, teils mit akutem Nierenversagen; bei einer dritten Gruppe treten beide Symptome auf. In der Diagnostik der NAST kommt der farbcodierten Dopplersonographie eine zentrale Rolle zu. Therapeutisch muss eine hämodynamisch relevante NAST gesichert sein, bevor eine interventionelle Therapie angestrebt wird. Die Therapie der NAST ist seit dem Erscheinen von randomisierten, kontrollierten Studien (RCT) Gegenstand intensiver Diskussionen. Die RCT konnten zeigen, dass nur bestimmte NAST durch eine interventionelle Therapie erfolgreich behandelt werden. Seitdem gewinnt die medikamentöse Therapie mehr und mehr an Bedeutung. Es stellt sich daher die Frage, welcher Befund von welcher Therapie wann profitiert? Was ist die „richtige“ medikamentöse Therapie der NAST? Welche Substanzen werden empfohlen?

Abstract

Arteriosclerotic renal artery stenosis (RAS) has an increased incidence in patients with cardiovascular risk factors. Clinically RAS presents in some patients as secondary, sometimes resistant arterial hypertension and in others as chronic renal insufficiency, sometimes with acute renal failure and in a third group both symptoms are observed. Doppler ultrasound plays a central role in the diagnosis of RAS. Therapeutically, it is important to identify hemodynamically relevant RAS before interventional therapy is initiated. The therapy of RAS has been under intensive debate since the publication of randomized controlled trials (RCT) which showed that only a subset of RAS can be successfully treated by interventional therapy. Since then the medicinal therapy of RAS has gained more and more impact. The following questions are raised: which forms of RAS can be treated by which therapy? What is the best medicinal therapy to treat RAS? What substances are recommended?

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  1. Klinik für Nephrologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    L.C. Rump & L. Sellin

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Rump, L., Sellin, L. Medikamentöse oder instrumentelle Therapie der Nierenarterienstenose?. Internist 53, 760–765 (2012). https://doi.org/10.1007/s00108-012-3038-1

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