Hopp til hovedinnhold

Kronisk nyresykdom

Sist oppdatert: Sist revidert:
Sist revidert av:
Definisjon:
Reduksjon i nyrenes filtrasjonsevne. Årsaksforholdene er avgjørende for sykdomsutviklingen, men skadene er som regel progressive og vil ubehandlet lede til uremi
Forekomst:
Ca. 10% av Norges voksne befolkning har noen grad av svekket nyrefunksjon
Symptomer:
Symptomfri i tidlige stadier. Vanligst ved uttalt nyresvikt er slapphet, kløe, kvalme, trøtthet, nokturi, restless legs, dyspné, gusten hudfarge
Funn:
Etter hvert svekket allmenntilstand. En rekke fysiske utslag, økende med økende svikt: Blekhet, hypertensjon, kardiomegali, ødemer, mentale forandringer
Diagnostikk:e
GFR, albumin-kreatininratio i urin. Blodtrykk, hjerte-kar-undersøkelse og HbA1c for å diagnostisere utløsende årsak. 
Behandling:
Livsstilstiltak og medikamentell behandling for å forsinke progresjon av tilstanden, behandling av komorbiditet. Dialyse og transplantasjon ved langtkommet sykdom. 
  • Nasjonal behandlingstjeneste for organtransplantasjon, Oslo universitetssykehus HF, nettsted 
  1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013. 3:1-150.
  2. KDIGO. Evaluation and Management of Chronic Kidney Disease. Recommendation Statements. Last updated march 22, 2022 www.guidelinecentral.com  
  3. Norsk nyremedisinsk forening. Norsk forening for allmennmedisin. Veileder for samhandling om pasienter med kronisk nyresykdom. Versjon 1 - februar 2023. nephro.no  
  4. Norsk Nyreregister. Årsrapport for 2021. Publisert 15.06.2022. www.kvalitetsregistre.no  
  5. Annual report 2019. The Norwegian Renal Registry. www.nephro.no  
  6. Webster AC, Nagler EV, Morton RL, et al. Chronic kidney disease. Lancet. 2017 Mar 25;389(10075):1238-52. PMID: 27887750 PubMed  
  7. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020 Feb 29;395(10225):709-33. PMID: 32061315 PubMed  
  8. Hartmann A, Midtvedt K, Witczak B. Nyreskader og nyresvikt utløst av legemidler. Tidsskr Nor Lægeforen 2004; 124: 2765-6. Tidsskrift for Den norske legeforening  
  9. Lee J, Nicholl DD, Ahmed SB, et al. The prevalence of restless legs syndrome across the full spectrum of kidney disease. J Clin Sleep Med 2013; 9: 455-9. PMID: 23674936 PubMed  
  10. Meyer TW, Hostetter TH. Uremia. N Engl J Med 2007; 357: 1316-25. PubMed  
  11. Crowe E, Halpin D, Stevens P et al. Early identification and management of chronic kidney disease: summary of NICE guidance. BMJ 2008; 337: a1530. BMJ (DOI)  
  12. Hartmann A. Kronisk nyresvikt. Norsk legemiddelhåndbok, sist oppdatert 03.02.2017. legemiddelhandboka.no  
  13. Navaneethan SD, Zoungas S, Caramori ML, et al. Diabetes management in chronic kidney disease: Synopsis of the KDIGO 2022 clinical practice guideline update. Ann Intern Med 2023. PMID: 36623286 PubMed  
  14. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med 2020; 383: 1436-1446. PMID: 32970396 PubMed  
  15. Schechter M, Jongs N, Chertow GM, et al. Effects of Dapagliflozin on Hospitalizations in Patients With Chronic Kidney Disease A Post Hoc Analysis of DAPA-CKD. Ann Intern Med 2022. pmid:36469914 PubMed  
  16. Nordal EJ, Os I. Uremisk kløe - patogenese og behandling. Tidsskr Nor Lægeforen 2007; 127: 1201-3. PubMed  
  17. Cooper BA, Branley P, Bulfone L, et al, for the IDEAL Study. A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med 2010; 363: 609-19. PubMed  
  18. Balamuthusamy S, Srinivasam L, Verma M, et al. Renin angiotensin system blockade and cardiovascular outcomes in patients with chronic kidney disease and proteinuria: a meta-analysis. Am Heart J. 2008 May;155(5):791-805. PMID: 18440325 PubMed  
  19. Palmer SC, Craig JC, Navaneethan SD, et al. Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med 2012; 157: 263-75. PubMed  
  20. Clement FM, Klarenbach S, Tonelli M, Johnson JA, Manns BJ. The impact of selecting a high hemoglobin target level on health-related quality of life for patients with chronic kidney disease. Arch Intern Med 2009; 169: 1104-12. PubMed  
  21. Svendsen EB, Christiansen R, Svarstad E, Aase S. En kvinne med kronisk nyresvikt, progredierende hudforkalkninger og sepsis. Tidsskr Nor Legeforen 2008; 128: 1295-6. Tidsskrift for Den norske legeforening  
  22. Rosenberg M. Overview of the management of chronic kidney disease in adults. UpToDate, last updated May 16, 2014. UpToDate  
  23. Orth SR, Hallan SI. Smoking: a risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients--absence of evidence or evidence of absence? Clin J Am Soc Nephrol 2008; 3:226. PubMed  
  24. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Accessed online May 19, 2004, at: http://www.kidney.org/professionals/kdoqi/guidelines_ckd/toc.htm.
  25. Helsedirektoratet. Nasjonal faglig retningslinje for behandling av diabetes. www.helsedirektoratet.no/diabetes. Oppdatert desember 2018. (01.02.2021)
  26. Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019 Jun 13;380(24):2295-2306. PMID: 30990260 PubMed  
  27. Pollock C, Stefanson B, Reyner D, et al. Albuminuria-lowering effect of dapagliflozin alone and in combination with saxagliptin and effect of dapagliflozin and saxagliptin on glycaemic control in patients with type 2 diabetes and chronic kidney disease (DELIGHT): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol . 2019; 7: 429-41. pmid:30992195 PubMed  
  28. Wheeler DC, Stefansson BV, Jongs N, et al. Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial. Lancet Diabetes Endocrinol. 2021; 9 :22-31. PMID: 33338413 PubMed  
  29. Kristensen SL, Rørth R, Jhund PS, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019 Oct;7(10):776-85. PMID: 31422062 PubMed  
  30. Rosenstock J, Wysham C, Frías JP, et al. Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial. Lancet2021;398:143-55. pmid:34186022 PubMed  
  31. Bakris GL, Agarwal R, Anker SD, et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. 2020 Dec 3;383(23):2219-2229. doi: 10.1056/NEJMoa2025845. Epub 2020 Oct 23. PMID: 33264825 PubMed  
  32. Pitt B, Filippatos G, Agarwal R, et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med. 2021 Dec 9;385(24):2252-2263. doi: 10.1056/NEJMoa2110956. Epub 2021 Aug 28. PMID: 34449181 PubMed  
  33. Bennett WM, Henrich WL, Stoff JS. The renal effects of nonsteroidal anti-inflammatory drugs: summary and recommendations. Am J Kidney Dis 1996; 28(1 suppl 1): 56-62.
  34. Huerta C, Castellsague J, Varas-Lorenzo C, Garcia Rodriguez LA. Nonsteroidal anti-inflammatory drugs and risk of ARF in the general population. Am J Kidney Dis 2005; 45: 531-9. PubMed  
  35. Fogari R, Zoppi A, Carretta R, Veglio F, Salvetti A, for the Italian Collaborative Study Group. Effect of indomethacin on the antihypertensive efficacy of valsartan and lisinopril: a multicentre study. J Hypertens 2002; 20: 1007-14. PubMed  
  36. Johnson CA, Levey AS, Coresh J, Levin A, Lau J, Eknoyan G. Clinical practice guidelines for chronic kidney disease in adults: Part I. Definition, disease stages, evaluation, treatment, and risk factors. Am Fam Physician 2004; 70: 869-76. PubMed  
  37. Angelantonio E, Chowdhury R, Sarwar N, et al. Chronic kdney disease and risk of major cardiovascular disease and non-vascular mortality: prospective population based cohort study. BMJ 2010; 341: c4986. BMJ (DOI)  
  38. Lee M, Saver JL, Chang K-H, et al. Low glomerular filtration and risk of stroke: meta-analysis. BMJ 2010; 341: c4249. BMJ (DOI)  
  39. Sæle K, Sønnesyn H, Svarstad E, Aarsland D. Kognitiv svikt ved terminal nyresykdom. Tidsskr Nor Legeforen 2009; 129: 296-9. Tidsskrift for Den norske legeforening  
  40. Hemmelgarn BR, Manns BJ, Lloyd A, et al. Relation between kidney function, proteinuria, and adverse outcomes. JAMA 2010; 303: 423-9. Journal of the American Medical Association  
  41. Norsk kvalitetsforbedring av laboratorieundersøkelser (Noklus). Kronisk nyresykdom. Siden besøkt 21.09.2020 www.noklus.no  
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Steinar Hunskår, professor i allmennmedisin, Institutt for samfunnsmedisinske fag, Seksjon for allmennmedisin, Universitetet i Bergen
  • Tor Erik Widerøe, professor, Norges teknisk-naturvitenskapelige universitet og overlege ved Seksjon for nyresykdommer, St. Olavs Hospital, Trondheim