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Aktuelle Strategien in der Therapie der Nierenarterienstenose

Current management of renal artery stenosis

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Zusammenfassung

Eine hämodynamisch wirksame Nierenarterienstenose kann zu unterschiedlichen Erkrankungen führen: bei unilateraler Stenose zu einer renovaskulären Hypertonie, bei bilateraler Stenose bzw. stenosierter Einzelniere zusätzlich zu einer ischämischen Nephropathie mit Niereninsuffizienz und zum akuten Lungenödem („pulmonary flush edema“). Kausal oft angestrebte revaskularisierende Verfahren – die Stentangioplastie und seltener chirurgische Verfahren – erreichen im Hinblick auf die Wiedereröffnung des Lumens eine hohe primäre technische Erfolgsrate. Besonders bei den katheterbasierten Interventionen bleiben jedoch die funktionellen Ergebnisse bezüglich des Blutdrucks (Ausnahme: fibromuskuläre Dysplasie) und der Nierenfunktion sowie die Komplikationsraten weniger überzeugend. Bisher unbewiesen ist, dass revaskularisierende Maßnahmen zu einer Verlängerung des ereignisfreien Überlebens führen. Im Einzelfall kann deren Einsatz jedoch notwendig und vertretbar sein.

Abstract

Severe renal artery stenosis may cause renovascular hypertension; in case of bilateral narrowing or in a stenotic solitary kidney, renal insufficiency (ischemic kidney disease) or rarely pulmonary flush edema may occur. Renal artery stenosis may be treated by revascularization, using either percutaneous (balloon angioplasty, stenting) or less common open surgical procedures, both with excellent primary patency rates. However, randomized trials of renal artery angioplasty or stenting have failed to demonstrate a longer-term benefit with regard to blood pressure control and renal function over medical management alone (except for fibromuscular disease). Furthermore, endovascular procedures are associated with substantial risks. It has not yet been demonstrated that renal revascularization leads to a prolongation of event-free survival. Careful patient selection is essential to maximize the potential benefit.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Lenz gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. KfH Nierenzentrum, Maxstr. 48, 67059, Ludwigshafen, Deutschland

    T. Lenz

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Lenz, T. Aktuelle Strategien in der Therapie der Nierenarterienstenose. Internist 54, 1443–1449 (2013). https://doi.org/10.1007/s00108-013-3324-6

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