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Nierenfunktion bei Diabetes — Was sind die besonderen Probleme?

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AT1-Rezeptorblockade

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Zusammenfassung

In den meisten westlichen Ländern ist die diabedsche Nephropathie die häufigste Ursache der Niereninsuffizienz. Vor diesem Hintergrund gewinnt die Rolle des Renin-Angiotensin- Systems und seiner pharmakologischen Blockade erhebliches Interesse. Bei diabedschen Patienten und diabetischen Versuchstieren ist die Plasma-Renin-Aktivität supprimiert. Obwohl die Datenlage nicht ganz einheidich ist, sprechen viele indirekte Argumente (Änderung der renalen Hämodynamik nach RAS-Blockade, AT1-Rezeptorexpression) dafür, daß die Niere einer vermehrten Angiotensin (ANG)-II-Wirkung ausgesetzt ist.

Es ist inzwischen gut gesichert, daß ACE-Hemmer bei Padenten mit Typ-I-(IDDM) und Typ-II-Diabetes (NIDDM) die Progression der Mikroalbuminurie hemmen. Sie verzögern auch bei niereninsuffizienten Padenten mit IDDM die Progression der Niereninsuffizienz. Für NIDDM ist die Datenlage weniger gut gesichert. Im Vergleich zu konvendonellen Andhypertensiva (mit der möglichen Ausnahme einiger Calciumantagonisten) sind ACE- Hemmer klar überlegen, aber diese Überlegenheit zeigt sich nur, wenn die Blutdruck werte im hochnormalen Bereich liegen oder erhöht sind.

Bei diabetischen Versuchstieren interferieren ANG-II-Rezeptorblocker mit der Entwicklung glomerulärer Veränderungen. Bei akuten und subakuten Untersuchungen an diabetischen Patienten verminderten ANG-II-Rezeptorblocker die Albuminurie stärker als Betablocker. Bei nicht-diabetischen Patienten zeigte der direkte Wirkungsvergleich zwischen äquipotenten Dosen von ACE-Hemmem und ANG-II-Rezeptorblockern eine gleich ausgeprägte Verminderung der Proteinurie. Die Langzeit-Effekte der ANG-II-Rezeptor- blocker auf die Progression der fortgeschrittenen diabetischen Nephropathie werden gegenwärtig in zwei großen intemationalen Studien untersucht. Die Ergebnisse werden allerdings nicht vor dem Jahr 2000 verfügbar sein.

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Authors and Affiliations

  1. Medizinische Universitätsklinik, Ruperto Carola Universität, Bergheimer Straße 58, D-69115, Heidelberg, Deutschland

    Prof. Dr. E. Ritz, G. Miltenberger-Miltenyi, J. Wagner & I. Rychlik

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  2. G. Miltenberger-Miltenyi
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  3. J. Wagner
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  4. I. Rychlik
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  1. Institut für experimentelle und klinische Pharmakologie und Toxikologie, Medizinische Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    Peter Dominiak

  2. Abteilung für Pathophysiologie, Zentrum für Innere Medizin, Universitätsklinikum Essen, Hufelandstrasse 55, 45122, Essen, Deutschland

    Gerd Heusch

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© 1999 Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt

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Ritz, E., Miltenberger-Miltenyi, G., Wagner, J., Rychlik, I. (1999). Nierenfunktion bei Diabetes — Was sind die besonderen Probleme?. In: Dominiak, P., Heusch, G. (eds) AT1-Rezeptorblockade. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-93701-9_20

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  • DOI: https://doi.org/10.1007/978-3-642-93701-9_20

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-642-93702-6

  • Online ISBN: 978-3-642-93701-9

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