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Osteologie 2012; 21(04): 274-278
DOI: 10.1055/s-0037-1621695
Osteonekrosen
Schattauer GmbH

Osteonekrosen bei Niereninsuffizienz

Osteonecrosis in renal insufficiency
U. Maus
1   Orthopädisches Zentrum der katholischen Kliniken Oldenburger Münsterland, St. Antonius-Stift Emstek
› Author Affiliations
Further Information

Publication History

eingereicht: 31 July 2012

angenommen: 01 August 2012

Publication Date:
04 January 2018 (online)

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Zusammenfassung

Osteonekrosen bei chronischen Nierenerkrankungen stellen insbesondere bei Dialysepatienten und nach Nierentransplantation eine schwerwiegende Komplikation dar. Diese Osteonekrosen treten gehäuft im Bereich des Femurkopfes, aber auch im Bereich von Humeruskopf, Talus, Humeruskondylen, distalen Femurkondylen, Kuboid und den Karpalknochen auf. Die Pathogenese der Erkrankung ist noch nicht abschließend geklärt, neben der Kortisoneinnahme werden verschiedene andere Risikofaktoren diskutiert. Die Diagnostik besteht neben der klinischen und laborchemischen Untersuchung aus radiologischen Verfahren. Neben den nativradiologischen Aufnahmen stellt die Kernspintomografie ein Verfahren mit einer hohen Sensitivität auch für frühe Veränderungen dar. Die therapeutischen Möglichkeiten reichen von der konservativen Therapie bis zu den gängigen operativen Verfahren zur Behandlung avaskulärer Knochennekrosen anderer Genese, wobei bei chronischen Nierenerkrankungen einige Besonderheiten gerade bei der endoprothetischen Versorgung von Hüftkopfnekrosen zu beachten sind. Der vorliegende Artikel soll einenÜberblicküber die renal bedingten Osteonekrosen bei Erwachsenen und Kindern sowieüber deren Therapie geben.

Summary

Osteonecrosis in chronic renal disease is a high risk complication for patients undergoing dialysis and after renal transplantation. Main localisation is the femoral head, followed by the humeral head, talus, humeral condyles, distal femoral condyles, cuboid and the carpal bones. So far, the pathogenesis remains unsolved, but several risk factors like cortisone intake are discussed. Besides the clinical examination and blood tests, the diagnosis is based on radiological findings. X-ray, as well as MRI are high sensitive tools detecting early changes in bone structure. Therapeutical options range from non-invasive treatment to the known surgical approaches of treating avascular bone necrosis. Some difficulties occur with endoprosthetic implantation in patients with chronic renal diseases. This review wants to provide an overview of osteonecrosis due to renal insufficiency in adults and children and the current therapeutical approaches.

Schlüsselwörter

Osteonekrosen - avaskuläre Nekrose - Hüftkopfnekrose - Niereninsuffizienz - Dialyse - Nierentransplantation

Keywords

Osteonecrosis - avascular necrosis - necrosis of the femoral head - renal insufficiency - dialysis - renal transplantation
 

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