Strategien der Progressionshemmung bei diabetischer Nephropathie - Blutzucker, Blutdruck und Lipidwerte leitlinien-gerecht einstellen

Das Auftreten und der Verlauf einer diabetischen Nephropathie hängen zum einen von genetischen Faktoren ab, zum anderen aber auch von der Güte der Stoffwechseleinstellung, der Kontrolle des Blutdrucks, dem Ausmaß der Albuminurie/Proteinurie und der Höhe der LDL-Cholesterinspiegel. Eine möglichst physiologische Diabeteseinstellung kann nicht nur das Auftreten einer diabetischen Nephropathie verhindern, sondern auch den Verlauf einer bereits manifesten Nephropathie günstig beeinflussen. Bei Patienten mit Diabetes mellitus wird eine Blutdruckeinstellung auf Werte unter 125/85 mmHg empfohlen. ACE-Hemmer und Angiotensin-II-Rezeptorantagonisten weisen unabhängig von ihrer blutdrucksenkenden Wirkung antiproteinurische und antiinflammatorische Wirkungen auf. Auch Statine wirken nephroprotektiv. Im fortgeschrittenen Stadium der diabetischen Nephropathie sollten die renale Anämie, die renale Osteopathie und die metabolische Azidose frühzeitig mitbehandelt werden.

The appearance and the course of a diabetic nephropathy are addicted to genetic factors, the quality of the metabolism attitude, control of the blood pressure, the extent of the albuminuria/proteinuria and the height of LDL cholesterol. A norm near diabetes attitude can prevent not only the appearance of a diabetic nephropathy but also influence the course of an already manifest nephropathy favourably. In patients with diabetes mellitus a blood pressure attitude is recommended on values below 125/85 mmHg. ACE Inhibitor and AT-1 blocker exhibit anti-proteinuric and anti-inflammatoric effects independently of their blood pressure-lowering effect. Also statins act in a nephroprotective way. In the advanced stage of the diabetic nephropathy renal anaemia, renal osteodystrophy and metabolical acidosis should early be discovered and consequently treated.

Key words

diabetic nephropathy - hypertension - renal insufficiency - renal anemia - renal osteodystrophy - metabolic acidosis

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1 Modification of Diet in Renal Disease

2 Diabetes Control and Complications Trial

3 intensified multifactorial intervention and cardiovascular outcome in type 2 diabetes

4 Anglo-Scandinavian Cardiac Outcomes Trial

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