Ursachen der chronischen Nierenschädigung in Patienten mit Lebererkrankungen – Pathophysiologie und Therapiemöglichkeiten

Florian Gunnar Scurt; Katrin Bose; Ali Canbay; Peter R Mertens; Christos Chatzikyrkou

doi:10.1055/a-1402-1502

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2021; 59(06): 560-579
DOI: 10.1055/a-1402-1502

Übersicht

Ursachen der chronischen Nierenschädigung in Patienten mit Lebererkrankungen – Pathophysiologie und Therapiemöglichkeiten

Chronic kidney injury in patients with liver diseases – Reappraising pathophysiology and treatment options

Florian Gunnar Scurt

¹Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Deutschland

²Health Campus Immunology, Infectiology and Inflammation, Otto von Guericke University, Magdeburg, Germany

,

Katrin Bose

²Health Campus Immunology, Infectiology and Inflammation, Otto von Guericke University, Magdeburg, Germany

³Universitätsklinik für Gastroenterologie, Hepatologie und Infektiologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Deutschland

,

Ali Canbay

⁴Ruhr-Universität Bochum, Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Deutschland

,

Peter R Mertens

¹Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Deutschland

²Health Campus Immunology, Infectiology and Inflammation, Otto von Guericke University, Magdeburg, Germany

,

Christos Chatzikyrkou

¹Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Deutschland

²Health Campus Immunology, Infectiology and Inflammation, Otto von Guericke University, Magdeburg, Germany

› Author Affiliations

Abstract

Zusammenfassung

Eine akute oder chronische Nierenschädigung bei gleichzeitig bestehender Lebererkrankung stellt ein häufiges Problem dar und geht im weiteren klinischen Verlauf mit zahlreichen Komplikationen sowie einer gesteigerten Dialysepflichtigkeit und Mortalität einher.

Die Prävalenz einer chronischen Niereninsuffizienz (CNI) bei Patienten mit Lebererkrankungen ist hoch, nicht zuletzt wegen parallel bestehender Komorbiditäten (z. B. metabolisches Syndrom, chronische Entzündungsprozesse, Hyperkoagulabilität, Hyperfibrinolyse, Diabetes mellitus, Dyslipidämie usw.). Doch nicht jede chronische Verschlechterung der Nierenretentionsparameter lässt sich auf ein hepatorenales Syndrom zurückführen. Neben diesem sind die häufigsten Ursachen der CNI bei bestehenden Lebererkrankungen die diabetische Nephropathie, die alkoholassoziierte IgA-Nephropathie, die mit Hepatitis C assoziierte membranoproliferative Glomerulonephritis und die mit Hepatitis B assoziierte membranöse Glomerulonephritis.

Koexistente Erkrankungen, ähnlich bzw. parallel ablaufende pathophysiologische Mechanismen und überlappende Erscheinungsbilder stellen hinsichtlich der Ursachenfindung und entsprechenden Behandlung der CNI im Rahmen einer existenten Lebererkrankung eine Herausforderung an den Kliniker dar. Diese Übersichtsarbeit skizziert sowohl häufige als auch seltene Entitäten, die zu einer chronischen Nierenschädigung in diesem speziellen Patientenkollektiv führen, und zeigt einen Überblick zu therapeutischen Möglichkeiten.

Abstract

Acute and chronic kidney disease concurs commonly with liver disease and is associated with a wide array of complications including dialysis dependency and increased mortality. Patients with liver disease or liver cirrhosis show a higher prevalence of chronic kidney disease. This is attributed to concomitant comorbidities, such as metabolic syndrome, chronic inflammation, hypercoagulability, hyperfibrinolysis, diabetes mellitus and dyslipidaemias. But chronic progressive kidney disease is not always due to hepatorenal syndrome. Beyond that, other diseases or disease entities should be considered. Among them are diabetic nephropathy, secondary IgA nephropathy, hepatitis C -associated membranoproliferative Glomerulonephritis (MPGN) and hepatitis B-associated membranous nephropathy.

Coexisting diseases, similar underlying pathophysiologic mechanisms, or simultaneously concurring pathophysiological processes and overlapping clinical manifestations, impede the etiologic diagnosis and corresponding treatment of chronic kidney disease in the setting of chronic liver disease. In this review, we focus on common and rare pathologies, which can lead to chronic kidney disease in this particular patient group and try to summarize the most recent therapeutic modalities.

Schlüsselwörter

Leberinsuffizienz - Leberzirrhose - Nierenschädigung - chronische Niereninsuffizienz - hepatorenales Syndrom - HRS - Hepatitis B - Hepatitis C - Diabetes mellitus - Pathophysiologie - Nierenbiopsie

Key words

liver insufficiency - liver cirrhosis - kidney injury - chronic renal insufficiency - hepatorenal syndrome - HRS - hepatitis B - hepatitis C - diabetes mellitus - pathophysiology - kidney biopsy

Full Text

References

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