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2015 | OriginalPaper | Buchkapitel

11. Arzneimittelinduzierte Nephrotoxizität

verfasst von: David Czock, Frieder Keller

Erschienen in: Akute Nierenschädigung

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Unerwünschte Arzneimittelwirkungen (UAW) auf die Nieren sind vielfältig und können zu akuter Nierenschädigung, chronischer Nierenerkrankung, Proteinurie und verschiedenen tubulären Syndromen führen. Risikofaktoren für eine akute Nierenschädigung durch Arzneimittel umfassen Höhe und Dauer der Exposition, eine vorbestehende Niereninsuffizienz, Arzneimittelwechselwirkungen, Volumenmangel, Urin-pH und genetische Faktoren. Bei der Indikationsstellung zur Behandlung mit kritischen Arzneimitteln sollte deshalb immer die geschätzte Nierenfunktion des Patienten, seine Begleiterkrankungen und die Komedikation berücksichtigt werden. Prophylaktische Maßnahmen umfassen neben einer sorgfältigen Dosierung (Infusionsgeschwindigkeit, ggf. Dosierungsanpassung) und einer Überwachung der Nierenfunktion manchmal auch die Hydrierung des Patienten, die Gabe von protektiven Arzneimitteln, eine Beeinflussung des Urin-pH sowie ein Therapeutisches Drug Monitoring (TDM) mit Messung von Arzneimittelkonzentrationen im Blut. Wenn eine UAW auf die Nieren vermutet wird, sind folgende Aspekte abzuwägen: Wahrscheinlichkeit, dass das beobachtete klinische Syndrom tatsächlich durch das Arzneimittel verursacht ist, Schwere des klinischen Syndroms, Dringlichkeit der Indikation für das als ursächlich vermutete Arzneimittel sowie die Verfügbarkeit alternativer Arzneimittel.
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Metadaten
Titel
Arzneimittelinduzierte Nephrotoxizität
verfasst von
David Czock
Frieder Keller
Copyright-Jahr
2015
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-642-45080-8_11

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