Nephrologisches Management und Medikamentendosierung bei Rheumapatienten mit Niereninsuffizienz – Teil 1

In patients with inflammatory rheumatic diseases and renal insufficiency there are two challenges for physicians: to adapt the antirheumatic medication to the renal function and to carry out a nephroprotective treatment that prevents long-term deterioration of renal function and reduces the elevated cardiovascular risk.

A literature search (in PubMed) was carried out and the current state of knowledge on nephroprotective treatment strategies and the treatment of rheumatic diseases in the presence of renal insufficiency was collated, evaluated and summarized.

Lifestyle interventions, especially the cessation of smoking and drug treatment strategies form the basis of nephroprotection including the control of diabetes mellitus with metformin, sodium glucose transporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP1) analogues and control of hypertension with blockade of the reninangiotensin-aldosterone system (RAAS), hyperlipidemia, hyperphosphatemia and metabolic acidosis.

In patients with rheumatism and impaired renal function, the risk of progression of renal insufficiency should be assessed by GFR (glomerular filtration rate) progression, proteinuria quantification, new urine markers if necessary, and renal biopsy. For nephro- and cardiovascular protection, lifestyle modifications and drug procedures are used, including consistent blood pressure control < 130 mm Hg systolic, SGLT2 (“sodium glucose transporter 2”) inhibitors in diabetic and non-diabetic nephropathy and guideline-compliant lipid lowering.