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Nephroprotektion bei konnatalen obstruktiven Uropathien

Nephroprotection in congenital obstructive uropathies

  • Leitthema
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Zusammenfassung

Experimentelle Studien in verschiedenen Tiermodellen ergaben, dass konnatale obstruktive Uropathien unkorrigiert zu einer irreversiblen Schädigung des Nierenparenchyms mit Tubulusatrophie, glomerulärer Sklerose und interstitieller Fibrose führen. Im Tierexperiment konnte die Nierenfunktion durch eine frühzeitige Korrektur der Obstruktion, den Einsatz von ACE-Hemmern (ACE: „angiotensin converting enzyme“) nach Abschluss der Nierenentwicklung, IGF („insulin-like growth factor“) oder EGF („epidermal growth factor“) positiv beeinflusst werden. In Analogie zu diesen Untersuchungen kann angenommen werden, dass sich eine möglichst frühzeitige Entlastung einer relevanten Obstruktion auch beim Säugling nephroprotektiv auswirkt, obwohl zur Frage des optimalen Zeitpunkts einer Korrekturoperation beim Menschen keine Studien vorliegen. Zum Einsatz potenziell nephroprotektiver Medikamente während der Phase der Obstruktion existieren beim Säugling keine Untersuchungen. Aufgrund ihrer unbekannten Effektivität und ihres nicht bekannten Risikos können Medikamente für den klinischen Gebrauch derzeit nicht empfohlen werden.

Abstract

Experimental studies in various animal models have shown that congenital obstructive uropathies lead to tubular atrophy, glomerular sclerosis and interstitial fibrosis damaging the renal parenchyme irreversibly. These models showed that early correction of the urinary tract obstruction, the use of ACE inhibitors after completion of nephrogenesis, as well as IGF or EGF had a protective effect on renal function. In analogy to these animal studies, early correction of a relevant urinary tract obstruction should also protect renal function in infants, although there are no studies investigating the optimal time for corrective surgery in infants. No investigations exist either for the use of potentially nephroprotective substances during infantile urinary tract obstruction. Since the risks and benefits of such medication are currently unknown, their use is not recommended.

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  1. Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstraße 1, 79106, Freiburg, Deutschland

    M. Pohl

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Pohl, M. Nephroprotektion bei konnatalen obstruktiven Uropathien. Monatsschr Kinderheilkd 158, 1217–1223 (2010). https://doi.org/10.1007/s00112-010-2249-6

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  • DOI: https://doi.org/10.1007/s00112-010-2249-6

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