Akutes Nierenversagen und Vaskulitis: Wann dran denken und was tun ?

Zusammenfassung

Die Nierenbeteiligung ist bei systemischen Autoimmunerkrankungen wie z.B. der ANCA-Vaskulitis häufig. Das akute Nierenversagen (ANV) limitiert die Prognose des Patienten und muss rechtzeitig erkannt werden. Das ANV verläuft jedoch symptomarm und daher stehen häufig zunächst extra-renale Krankheitssymptome im Vordergrund. Zur Beurteilung einer Nierenbeteiligung sind die Retentionsparameter, vor allem aber die Urinanalyse von Bedeutung. Die Nierenbiopsie ist das Verfahren der Wahl zur Bestätigung der Diagnose. Die Behandlung muss auf die Krankheitsschwere der ANCA-Vaskulitis abgestimmt sein und in Fällen mit schwerem Organversagen müssen extrakorporale Verfahren wie die Plasmapherese erwogen werden. Die immunsuppressive Erhaltungstherapie is notwendig um Rezidive zu verhindern und die Patienten müssen engmaschig überwacht werden, um renale Krankheitsaktivität frührzeitig zu erkennen.

Abstract

Renal involvement in systemic autoimmune diseases such as ANCA-vasculitis is common. Acute kidney injury (AKI) limits the prognosis of the patient and needs to be detected early. However, AKI is in early phases clinically inapparent and at first contact with the patient, extra-renal symptoms may dominate the clinical presentation. Serum-Creatinine and urinary analysis provide useful information on the extent of renal involvement. A renal biopsy should confirm the diagnosis. Treatment needs to be adapted to the extent of ANCA-vasculitis and in cases with severe organ failure plasmapheresis should be performed. Maintenance immunosuppressive is necessary to prevent relapses and the patients should be monitored closely to detect renal flares early.

Schlüsselwörter

akutes Nierenversagen - ANCA-assoziierte Vaskulitis - Vaskulitis - Lupus erythematodes

Key Words

acute kidney injury - ANCA-associated vasculitis - vasculitis - lupus erythematosus

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