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Proteinurie und Blocker des Renin-Angiotensin-Aldosteron-Systems

Neue Erkenntnisse zu Pathogenese und Therapie

Proteinuria and renin-angiotensin-aldosterone system blockers

New aspects of pathogenesis and therapy

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Der Diabetologe Aims and scope

Zusammenfassung

Bei Diabetespatienten korreliert eine Mikroalbuminurie mit einem massiv erhöhten Risiko für die Entwicklung einer koronaren Herzkrankheit. Um dieses Risiko zu senken und gleichzeitig die Progression der diabetischen Nephropathie aufzuhalten, werden frühzeitig Medikamente eingesetzt, die das Renin-Angiotensin-Aldosteron-System (RAAS) hemmen. Über die Öffnung der efferenten Gefäße wird Druck von den Glomeruli genommen; dies übt eine nephroprotektive Wirkung aus. Der Erkenntniszuwachs auf diesem speziellen Gebiet der Nephrologie hat über die letzten Jahre hinweg zu wesentlichen therapeutischen Fortschritten geführt. Der hier vorgelegte Beitrag bewertet bisher wenig beachtete Befunde der letzten 20 Jahre, die die Sicht auf die Pathogenese und Therapie der Proteinurie signifikant erweitern, aus klinischer Sicht neu. Zur Komplettierung des gegenwärtigen pathogenetischen Modells werden aktuelle Befunde berücksichtigt.

Abstract

In diabetes patients microalbuminuria correlates with a massively increased risk for the development of coronary heart disease. In order to reduce this risk and simultaneously the progression of diabetic nephropathy, medication which inhibits the renin-angiotensin-aldosterone system (RAAS) is administered at an early stage. By opening the efferent vessels pressure is taken off the glomeruli, which has a nephroprotective effect. The increase in knowledge in this special field of nephrology has led to substantial therapeutic progress in recent years. In this article the previously less well known results over the last 20 years which have significantly broadened the view on the pathogenesis and therapy of proteinuria, will be reassessed from a clinical perspective. To complete the present day pathogenetic model, current results will be taken into account.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. T.H. Lindner weist auf folgende Beziehung hin: Honorarvorträge für die Fa. Novartis. Dieser Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Department für Innere Medizin, Neurologie und Dermatologie, Klinik für Endokrinologie und Nephrologie, Sektion Nephrologie, Universitätsklinikum Leipzig – AöR, Liebigstr. 20, 04103, Leipzig, Deutschland

    T.H. Lindner

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Correspondence to T.H. Lindner.

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Lindner, T. Proteinurie und Blocker des Renin-Angiotensin-Aldosteron-Systems. Diabetologe 9, 622–630 (2013). https://doi.org/10.1007/s11428-013-1089-0

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