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Erschienen in: Die Nephrologie 5/2020

29.04.2020 | Arteriosklerose | Leitthema

Kardiovaskuläre Kalzifikationen bei chronischer Niereninsuffizienz

verfasst von: Dr. N. Kaesler, R. Kramann, J. Floege

Erschienen in: Die Nephrologie | Ausgabe 5/2020

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Zusammenfassung

Chronische Nierenerkrankungen sind weiterhin weltweit auf dem Vormarsch. Damit einhergehende lebenslimitierende kardiovaskuläre Kalzifikationen entstehen aus einem komplexen Zusammenspiel an Promotoren (Kalzium, Phosphat, Parathormon) und Inhibitoren (Magnesium, Matrix-Gla-Protein, Pyrophosphat, Fetuin-A), Calciproteinpartikeln und Apoptosekörperchen. Im Rahmen des Geschehens wandeln sich verschiedene Zelltypen der Gefäßwand in Zellen mit knochenähnlichen Eigenschaften und Markern um. Die extrazelluläre Matrix wird umgebaut, und ist hier erst ein Kalziumphosphatkristall ausgefallen, triggert dies die Anlagerung von weiteren und größeren Kristallen. Verkalkungen können intimal im Rahmen von Atherosklerose sowie medial im Rahmen von Arteriosklerose auftreten. Oftmals finden sich bei chronisch niereninsuffizienten Patienten beide Formen. Eine weitere Manifestation sind valvuläre Kalzifikationen, welche ebenfalls vermehrt bei niereninsuffizienten Patienten auftreten. Nachgewiesen werden bestehende Verkalkungen am empfindlichsten mittels Computertomographie. Prädiktiv kann das Kalzifizierungshemmungspotenzial im Serum mittels T50-Assay ermittelt werden. Bestehende Therapien sind nach wie vor unzureichend. Ansätze liegen in der Normalisierung des Kalzium-Phosphat-Produkts, der Therapie eines sekundären Hyperparathyreoidismus, und – bisher noch experimentell – der Gabe von Vitamin K, Pyrophosphat, Inositolphosphaten und Natriumthiosulfat.
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Metadaten
Titel
Kardiovaskuläre Kalzifikationen bei chronischer Niereninsuffizienz
verfasst von
Dr. N. Kaesler
R. Kramann
J. Floege
Publikationsdatum
29.04.2020
Verlag
Springer Medizin
Erschienen in
Die Nephrologie / Ausgabe 5/2020
Print ISSN: 2731-7463
Elektronische ISSN: 2731-7471
DOI
https://doi.org/10.1007/s11560-020-00429-3

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