Atherosklerotische Nierenarterienstenose

Zusammenfassung

Die Atherosklerose ist mit etwa 90 % die häufigste Ursache einer Nierenarterienstenose. Eine atherosklerotische Nierenarterienstenose kann mit einer renovaskulären Hypertonie, einer ischämischen Nephropathie oder Beidem assoziiert sein, sie kann aber auch asymptomatisch bleiben. Die Prävalenz unter Hypertonikern beträgt zwischen 1 und 5 %, deutlich häufiger findet man eine Nierenarterienstenose bei Patienten mit therapierefraktärer Hypertonie (20 Prozent), koronarer Herzkrankheit (15 bis 20 %) oder peripherer arterieller Verschlusskrankheit (30 bis 40 %). Als diagnostischer Goldstandard gilt die konventionelle Nierenarterien-Angiografie. Unter den nicht-invasiven Screeningmethoden besitzen die Magnetresonanz (MR)-Angiografie, die Computertomografie (CT)-Angiografie und die farbkodierte Duplexsonografie die höchste diagnostische Wertigkeit. Die Basis der Therapie stellt eine konsequente medikamentöse Behandlung der arteriellen Hypertonie, Thrombozytenaggregationshemmer und die Modifikation atherosklerotischer Risikofaktoren dar. Eine Revaskularisation wird für Patienten mit schwerer Hypertonie, Patienten mit rezidivierenden Lungenödemen und bei aktueller Verschlechterung der Nierenfunktion empfohlen. Als Revaskularisationsmethode erster Wahl gilt die perkutane transluminale Angioplastie (PTA) mit Stentimplantation. Die Prognose von Patienten mit atherosklerotischer Nierenarterienstenose ist im Wesentlichen durch das Auftreten kardiovaskulärer und renaler Komplikationen bestimmt.

Summary

The most common cause of obstructive renal artery disease is atherosclerosis, accounting for 90 % of cases of renal artery stenosis. Atherosclerotic renal artery stenosis can be associated with renovascular hypertension, ischemic nephropathy, or both or it may occur alone. The prevalence of atherosclerotic renal artery stenosis among hypertensive patients is estimated between 1 and 5 %, but the frequency rises among patients with refractory hypertension (20 %) coronary heart disease (15 to 20 %) or peripheral arterial disease (30 to 40 %). The gold standard for diagnosing renal artery disease is contrast renal arteriography. MR angiography, CT angiography and color duplex ultrasonography have the highest sensitivity and specifity among the non invasive screening methods. Therapy is based on consequent medical treatment of hypertension, antiplatelet therapy and modification of risk factors for atherosclerosis. Revascularisation is advised in patients with severe hypertension, in patients with pulmonary edema and cases of acute worsening of renal function. Percutaneous angioplasty with stent implantation is the method of choice for revascularisation. The prognosis of patients with atherosclerotic renal artery stenosis is determined by cardiovascular and renal complications.

Schlüsselwörter

Nierenarterienstenose - renale Hypertonie - ischämische Nephropathie - Atherosklerose

Key words

renal artery stenosis - renal hypertension - ischemic nephropathy - atherosclerosis

Literatur

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