Die Prävalenz der Nierenarterienstenose (NAST) in der Altersgruppe > 65 Jahre wird in der Literatur mit 6,8% angegeben. Bei Patienten mit bekannter oder vermuteter Arteriosklerose, bei denen eine Darstellung der Nierenarterien im Rahmen einer Koronarangiographie durchgeführt wird, findet sich eine deutlich höhere Häufigkeit von 11–23%. Trotz dieser hohen Prävalenz sind die Indikationen zur Revaskularisation umstritten. Die Anzahl interventioneller Eingriffe an Nierenarterien hat zugenommen, obwohl bekannt ist, dass bis zu 40% der Patienten weder im Hinblick auf die arterielle Hypertonie noch im Hinblick auf die Nierenfunktion von diesem Eingriff profitieren. Diese Tatsache unterstreicht, dass bei der Therapieentscheidung sowohl morphologische als auch funktionelle Aspekte berücksichtigt werden müssen. Zur morphologischen Evaluation einer NAST stehen heute die Computertomographie, die Magnetresonanztomographie sowie als Goldstandard die Angiographie zur Verfügung. Als wichtigstes funktionelles Verfahren ist die Doppler-Sonographie zu nennen, aber auch die intravasale Druck- und Flussmessung stellen wichtige Methoden dar, deren prädiktive Wertigkeit im Hinblick auf den Langzeiterfolg einer Intervention jedoch noch untersucht werden muss. Obwohl die perkutane Revaskularisation einer NAST im Vergleich zum operativen Vorgehen mit einer deutlich geringeren Komplikationsrate einhergeht, muss immer berücksichtigt werden, dass durch die notwendige Kontrastmittelgabe auch eine Verschlechterung der Nierenfunktion verursacht werden kann und dass daher eine sorgfältige Indikationsstellung wichtig ist.

Renal artery stenosis (RAS) is both a common and progressive disease and its prevalence in patients > 65 years is 6.8%. In patients with known or suspected atherosclerosis undergoing coronary angiography, a frequency of even 11-23% is reported in the literature. Despite this high prevalence, there is an ongoing discussion about the indications for revascularization and it is currently unclear, whether renal artery revascularization reduces adverse cardiovascular and renal events. Nevertheless, the number of interventions for RAS is rising steadily, although up to 40% of patients do not profit from this intervention. This fact underlines the necessity of a thorough diagnostic work-up before intervention, integrating morphological and functional tests. For morphological evaluation, multislice computed tomography, magnetic resonance tomography or digital subtraction angiography can be done. In experienced centers, Doppler ultrasound can serve as an excellent functional tool, to assess the physiological relevance of an RAS, but also invasive measurements of pressure and flow provide valuable information about the significance of stenoses; however, these methods will have to be assessed with respect to their value to predict long-term outcome. Although percutaneous intervention of RAS is associated with a substantially lower risk of major adverse events as compared to surgery, by using contrast media this procedure holds the risk of deterioration of renal function and of a small number of procedure-dependent complications as well. Thus, a careful consideration of pros and cons of this procedure is mandatory.

Objectives: The study was conducted to assess the health-related quality of life of kidney donors one year or longer after donation. Methods: Kidney donors were asked to answer a set of questionnaires measuring sociodemographic data as well as psychological distress (BSI), health-related quality of life (SF-36), and several questions regarding donation (modified EUROTOLD questionnaire), one year or longer after donation. Results: 47 out of 65 patients answered. All donations were successful to the day of investigation. Time between donation and participation in the survey was on average 31 months (standard deviation 14 months, range 12–72 months). 16 donors (34%) were male and 31 (66%) female. The majority was married (37, 79%), only a few widowed (2, 4%) and divorced or living separately (8, 17%). The majority donated the kidney to his/her son (15, 32%) or daughter (7, 15%), the wife (7, 15%) or husband (5, 11%), donations to sister or brother (6, 13%), parents (4, 8%), nephew, foster-daughter or stepson (each 1) were less frequent. On average, there was no measurable psychological distress in the group of 47 donors; only 6 (13%) donors demonstrated remarkable psychological distress. Health-related quality of life in terms of physical capacity and emotional role functioning was lower compared with normative data; and higher regarding general health perception, vitality, and psychological well-being (p < 0.001). Conclusion: Two or three years after successful kidney donation donors report better health-related quality of life than normative samples regarding general health perception, vitality and psychological well-being; only very few donors were markedly psychologically distressed. These results could be the effect of a specific selection before kidney donation (rejection of potentially donors suffering from severe psychological or physical illness). On the other hand, the successful donation and the positive consequences for family life (termination of dialysis etc.) could enrich one&'s life. Living kidney donation seems to restrict physical capacity and emotional role function; future studies should differentially investigate these contradictory results.

Drei türkische Patienten zwischen 23 und 32 Jahren stellten sich mit akuten Abdominalschmerzen und Fieber vor. Bei allen traten seit Jahren diese Beschwerden rezidivierend im Abstand von Wochen auf und sistierten nach zwei bis drei Tagen. Einer der Patienten entwickelte infolge einer Amyloidnephropathie eine terminale Niereninsuffizienz.

For 2 years a 52-year-old man had repeated bouts of purpura, arthralgia and fever. He was known to have abnormal monoclonal gammaglobulins, type IgG-lambda and vasculitis when he had another bout with acute renal failure and necrotizing ulcers in the legs.Several laboratory tests were abnormal: erythrocyte sedimentation rate (122 mm), haemoglobin level (9.1 g/dl), white cell count (32,000/microliters), platelet count (562,000/microliters), creatinine level (4.1 mg/dl) and liver enzyme activities. He also had proteinuria (4.5 g daily) and nephritic urinary sediments. The immunoglobulin was subtype IgG3, and a cryoglobulinaemia was also present. Total complement level (CH 50) was not measurable. Bone marrow aspirate revealed plasmocytoma infiltration, and renal biopsy demonstrated necrotizing arteritis, as well as granular subendothelial deposits of IgG and complement.After three plasma separations and initiation of the first treatment cycle with a four-day infusion of vincristine, doxorubicin and dexamethasone the creatinine concentration fell to within the normal range and the necroses healed slowly. No cryoglobulin activity has been demonstrable over the past 24 months.