Bisphosphonate und Niere

Zusammenfassung

Bisphosphonate sind heute fester Bestandteil derTherapie bei verschiedenen Knochenerkrankungen. Nach der Aufnahme in den Blutkreislauf werden sie entweder in den Knochen aufgenommen oder unmetabolisiert renal ausgeschieden. Hierbei wird auch bei jeder I nfusion ein geringer Teil in den Tubuluszellen abgelagert. Dies kann bei Kumulation zu einem teilweise irreversiblen Nierenversagen führen. Bei eingeschränkter Nierenfunktion ist die Bisphosphonatausscheidung reduziert, so dass bei den verschiedenen Bisphosphonaten in unterschiedlichem Maß die Dosis reduziert werden muss. Teilweise sind bestimmte Bisphosphonate bei schwer eingeschränkter Nierenfunktion sogar kontraindiziert. Dies gilt vor allem für den Indikationsbereich der Onkologie. Bei osteologischen Indikationen wird die Bisphosphonatgabe allgemein wegen fehlender Daten bei einer schwer eingeschränkten Nierenfunktion nicht mehr empfohlen. Bei dringender Indikation können hier jedoch die Dosisempfehlungen in der Onkologie weiterhelfen.

Summary

Bisphosphonatesare today’sstandard treatmentin different diseases ofthe bone. After their uptake by the blood circulation they are well absorbed by the bone or eliminated unmetabolized by the kidney. A small amount of the substance will be retained and deposited in cells ofthe proximal tubule. Acute and sometimes irreversible renal failure occurs if the bisphosphonates accumulate in the kidney. Renal excretion of bisphosphonates is reduced in renal insufficiency. This means that the dosage of different bisphosphonates has to be adapted accordingly. In severe renal insufficiency some bisphosphonates may not be indi- cated.This holds true especially for the field of oncological indications. In osteological ailments most bisphosphonates are even contraindicated in severe renal insufficiency. On the other hand, dosis recommendations taken from oncology may be helpful if treatment is needed in patients with osteoporosis and with severe renal failure.

Schlüsselwörter

Bisphosphonate - Niereninsuffizienz - Dosisanpassung - Alendronat - Clodronat - Ibandronat - Pamidronat - Risedro- nat - Zoledronat

Keywords

Bisphosphonate - renal insufficiency - adaptation of dosage - alendronate - clodronate - ibandronate - pamidronate - rise- dronate - zoledronate

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