Dialyse aktuell 2020; 24(05/06): 212-221
DOI: 10.1055/a-1121-0679
Schwerpunkt
Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Diabetische Nephropathie

Eine aktuelle Übersicht
Martin Busch
1   Klinik für Innere Medizin III, Universitätsklinikum Jena
,
Gunter Wolf
1   Klinik für Innere Medizin III, Universitätsklinikum Jena
› Author Affiliations
Further Information

Publication History

Publication Date:
23 July 2020 (online)

ZUSAMMENFASSUNG

In der deutschen Bevölkerung leiden 8–9 % an Diabetes mellitus. Vor allem die ältere Bevölkerung ist betroffen, häufiger in den neuen Bundesländern. Die Gesamtprävalenz einer Nierenerkrankung bei Diabetikern wird in Deutschland mit 15 % angegeben. Bis zu 40 % der Patienten mit Diabetes mellitus entwickeln im Verlauf eine Nephropathie. Diabetesdauer, höheres Alter, Blutzucker- und Blutdruckeinstellung sind Einflussfaktoren, auch bislang nicht vollständig charakterisierte (poly)genetische Faktoren. Die Verdachtsdiagnose einer diabetischen Nephropathie erfolgt beim Nachweis einer Mikroalbuminurie und/oder anderweitig nicht erklärbarer Einschränkung der geschätzten („estimated“) glomerulären Filtrationsrate (eGFR). Beweisend ist nur eine Nierenbiopsie, die jedoch selten indiziert ist. Andere oder Koentitäten sind dennoch häufig. Zur Prävention und Progressionshemmung einer Nephropathie sollte ein individualisierter HbA1c-Korridor von 6,5–7,5 % angestrebt werden. Basierend auf einer Metformintherapie sind bei Typ-2-Diabetes dann SGLT-2-Hemmer und GLP-1-Agonisten bevorzugt einzusetzen, da sie eigenständige nephro- und kardioprotektive Effekte aufweisen. Typ-1-Diabetiker sind intensiviert mit Insulin zu behandeln. Eine adäquate Blutdruckkontrolle sollte mittels Blockade des Renin-Angiotensin-Systems erfolgen. Gewichtsreduktion, körperliche Aktivität, Beendigung des Rauchens sowie Behandlung einer Dyslipidämie sind weitere Maßnahmen.

 
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