Das Verständnis der Regulationsmechanismen ist bei chronischer Niereninsuffizienz von grundlegender Bedeutung, da sie die Menge an Natrium und freiem Wasser im Körper beeinflussen. Die Natriumrestriktion spielt bei der Therapie eine zentrale Rolle. Diuretika sind der medikamentöse Standard, aber seit einiger Zeit rücken SGLT-2-Inhibitoren und Mineralkortikoid-Rezeptorantagonisten (MRA) immer weiter in den Fokus.
Abstract
Understanding the (patho-)physiology of volume regulation and osmoregulation is fundamental to guide patient advice and therapy in chronic kidney disease (CKD). Volume regulation primarily impacts the amount of sodium in the body, and it mainly affects the extracellular space, while osmoregulation primarily impacts the amount of free water, and it affects both the intra- and extracellular space. The kidneys control water and sodium homeostasis both through their sensor (e. g. tubuloglomerular feedback) and regulator systems (e. g. sodium reabsorption). Many CKD patients are advised by non-nephrologists to a high fluid intake, although they often do not require a daily intake of more than 1.5 litres. Many CKD patients are hypervolemic, and sodium restriction is of key importance in patients’ effort to utilize lifestyle changes as therapeutic means. Pharmacologically, (particularly loop) diuretics are the basis of therapy, increasing sodium excretion. Recent developments shift the focus towards classes of drugs ameliorating prognosis in CKD: sodium-glucose linked transporter 2 (SGLT2) inhibitors have proven beneficial in heart and renal failure – by sodium and fluid excretion, among others; additionally, a novel mineralocorticoid receptor antagonist (MRA), finerenone, was recently shown to improve prognosis in CKD.
Schlüsselwörter
Volumenhaushalt - Osmoregulation - chronische Nierenerkrankung - Diuretika - SGLT-2-Inhibitoren - Mineralkortikoid
Key words
volume balance - osmoregulation - chronic kidney disease - diuretics - SGLT-2 inhibitors - mineral corticosteroids
