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Metabolisches Syndrom und Nierenkrankheiten

Metabolic syndrome and kidney diseases

Zusammenfassung

Das Metabolische Syndrom (MetS) wurde erstmalig Ende der 80er-Jahre beschrieben und ist definiert durch das simultane Vorliegen von minimal 3 der folgenden 5 Komponenten: Adipositas, Dyslipoproteinämie, Glukoseintoleranz bzw. Diabetes mellitus Typ 2, arterielle Hypertonie. Durch die weltweite Verbesserung der Lebensumstände, vergesellschaftet mit einer Zunahme der Zivilisationskrankheiten wie Adipositas und Bluthochdruck, ist eine steigende Inzidenz des MetS seit Jahrzehnten zu beobachten. Das MetS ist ein Cluster kardiovaskulärer Risikofaktoren, welche die Entwicklung und Progression einer chronischen Niereninsuffizienz negativ beeinflussen. Durch zahlreiche pathophysiologische Veränderungen befindet sich der Metabolismus in einem proinflammatorischen Dauerzustand und auf zellulärer Ebene unter zunehmendem oxidativen Stress. Die Niere als das Organ mit zentraler Funktion zur Erhaltung der Körperhomöostase wird durch die physiologischen Veränderungen im Rahmen eines MetS in Mitleidenschaft gezogen. Eine vorzeitige Entwicklung einer chronischen Niereninsuffizienz bzw. eine Akzeleration und Progression dieser sind mit den einzelnen Komponenten des MetS assoziiert. Bioptisch können adipositasassoziierte Veränderungen wie die adipositasassoziierte Glomerulopathie (ORG), definiert als Glomerulomegalie mit oder ohne fokal-segmentale Glomerulosklerose, nachgewiesen werden. Die Therapie des MetS richtet sich in erster Linie nach den Leitlinien der Fachgesellschaften der einzelnen oben genannten Komponenten, welche individuell bei jedem einzelnen Patienten zu eruieren sind. Das Verständnis dieser komplexen Entität unter Berücksichtigung der Pathophysiologie und der damit verbundenen Beeinträchtigung des Zusammenspiels fast aller Organsysteme wuchs in den letzten Jahren rasant, v. a. da diese in weiten Teilen ungeklärt bleiben.

Abstract

Metabolic syndrome (MetS) was first described in the late 1980s and is defined by the simultaneous presence of at least three of the following five components: obesity, dyslipoproteinemia, glucose intolerance or diabetes mellitus type 2 and arterial hypertension. Due to the worldwide improvement of living conditions associated with an increase in diseases of civilization, such as obesity and hypertension, an increasing incidence of MetS has been observed for decades. The MetS is a cluster of cardiovascular risk factors that negatively influence the development and progression of chronic renal failure. Due to numerous pathophysiological changes, the metabolism is in a proinflammatory steady state and under increasing oxidative stress at the cellular level. The kidneys, as the organ with a central function to maintain body homeostasis, is affected by the physiological changes in the context of a MetS. A premature development of chronic renal failure or acceleration and progression of this is associated with the individual components of MetS. Bioptically, obesity-associated changes, such as obesity-related glomerulopathy (ORG), defined as glomerulomegaly with or without focal segmental glomerulosclerosis, can be detected. Treatment of MetS is primarily guided by professional society guidelines for each of the above components, which must be elicited individually for each patient. The understanding of this complex entity, taking the pathophysiology and the associated impairment of the interplay of almost all organ systems into account, has grown rapidly in recent years, especially as these remain largely unexplained.

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Correspondence to Maximilian J. Ganz or Florian G. Scurt.

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M.J. Ganz, S.T. Bender, C. Gross, K. Bose, P.R. Mertens und F.G. Scurt geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Uwe Heemann, München

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Ganz, M.J., Bender, S.T., Gross, C. et al. Metabolisches Syndrom und Nierenkrankheiten. Nephrologie 17, 291–303 (2022). https://doi.org/10.1007/s11560-022-00595-6

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Schlüsselwörter

  • Adipositas
  • Bluthochdruck
  • Diabetes mellitus
  • Inflammation
  • Chronische Niereninsuffizienz

Keywords

  • Obesity
  • Hypertension
  • Diabetes mellitus
  • Inflammation
  • Chronic renal insufficiency