Nierenarterienstenose: Neue Erkenntnisse und Entwicklungen

Es ist bekannt, dass hochgradige Stenosierungen der Nierenarterien über die eine Aktivierung des Renin-Angiotensin-Aldosteron-Systems (RAAS) zu arterieller Hypertonie führen. Die häufigste Form der Nierenarterienstenose (NAST) ist die arteriosklerotisch bedingte ostiale Stenose. Sie neigt zur Progression, führt zur renovaskulären Hypertonie und zum Parenchymuntergang der Niere (ischämische Nephropathie). Gleichwohl ist die Indikation zur Revaskularisation nach den letzten negativen Stentangioplastie-Studien [1, 2] umstritten. Obwohl gute prospektive Studien fehlen, werden folgende Faktoren als Revaskularisationsindikationen akzeptiert [3–5]: ▶ rezidivierende, hypertensiv getriggerte Linksherzinsuffizienz, ▶ progrediente Verschlechterung der Nierenfunktion und ▶ unkontrollierte Hypertonie mit mehr als 3 Antihypertensiva bei trunkaler Stenoselokalisation. Die selteneren Formen der NAST, die in der Regel Ursache der typischen RAAS-getriggerten sekundären Hypertonie sind, gelten unverändert als primäre Revaskularisationsindikation [6–9]. Hierzu zählen fibromuskuläre Dysplasie, Arteriitis, Transplant-Nierenarterienstenose und externe Kompression.

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