Die Niere ist ein vielfältiges und äusserst wichtiges Organ. Jeder gesunde Mensch besitzt zwei Nieren. Ein Leben ist allerdings auch mit nur einer Niere möglich. Verschiedene angeborene und erworbene, gut- und bösartige Erkrankungen können die Nieren schädigen. Sie befinden sich rechts und links neben der Wirbelsäule hinter dem Bauchfell in Höhe der elften bis zwölften Rippe und haben in etwa die Grösse einer geballten Faust.
Die Nieren haben folgende Funktionen:
Ausscheidung der Gift- und Abfallstoffe über den Urin
Regulierung des Flüssigkeits- und Elektrolythaushaltes
Regulierung des Säure- und Basenhaushalts
Bildung roter Blutkörperchen
Krankheitsbilder und Behandlungen
Nieren- und Harnleitersteine
Bis zu 15 % der Bevölkerung erkranken im Laufe Ihres Lebens an einem Harnsteinleiden. Männer sind doppelt so häufig betroffen. Die Wahrscheinlichkeit für die Betroffenen im Laufe ihres Lebens erneut Steine zu bilden, liegt bei rund 50 %. Mithilfe der richtigen Massnahmen lässt sich das Risiko reduzieren.
Symptome:
Schmerzen
Übelkeit
Erbrechen
häufige Toilettengänge
Blut im Urin
bei Fieber oder Schüttelfrost, sollte man sich umgehend in ärztliche Behandlung begeben.
Diagnose:
Labor: Blut- und Urinuntersuchungen
Computertomographie: Neben einer Blut- und Urinuntersuchung ist in der Regel die Durchführung einer Computertomographie notwendig. Hiermit kann die Lage und Grösse eines Harnsteines sicher bestimmt werden.
Behandlungen:
Zur Behandlung der Harnsteine stehen vielfältige Therapiemöglichkeiten zur Verfügung und müssen individuell angepasst werden. Bei kleineren Steinen von bis zu 4 mm Grösse kann ein spontaner Steinabgang abgewartet werden. Die Erfolgswahrscheinlichkeit liegt hier bei bis zu
75 %. Um die Schmerzen zu reduzieren, kommen Medikamente zum Einsatz. Zur Behandlung können verschiedene Methoden zum Einsatz kommen:
operative Methode: Hiermit können Steine aus der Niere oder dem Harnleiter endoskopisch mit einer feinen Zange oder einem Körbchen entfernt werden. Sollten die Steine zu gross sein, werden sie mittels Laser zerkleinert. Je nach Lage und Grösse der Harnsteine kann auch eine endoskopische Entfernung durch die Haut über die Flanke zum Einsatz kommen.
Schallwellen: In ausgewählten Fällen kann eine Zertrümmerung der Harnsteine von aussen durch Schallwellen erfolgen mittels Extrakorporeller Stosswellentherapie (ESWL).
Prophylaxe: Trinken von vorzugsweise Calcium-reichem Mineralwasser/Hahnenwasser mit dem Ziel einer Urinausscheidung von mind. 2 Litern pro Tag kann Nieren- und Harnleitersteine vorbeugen.
Hierbei handelt es sich um eine meist angeborene oder seltener erworbene Engstelle am Abgang des Harnleiters aus dem Nierenbecken. Ursächlich hierfür kann eine kreuzende Nierenarterie am Unterpol der Niere sein oder eine narbige Verengung. Männer sind doppelt so häufig davon betroffen wie Frauen. Durch den daraus resultierenden Aufstau des Urins im Nierenbecken kann die Niere in ihrer Funktion erheblich geschädigt werden. Daher ist eine Behebung der Abflussstörung wichtig.
Symptome:
chronische Rückenbeschwerden
Blut im Urin
fieberhafte Harnwegsinfekte
Nierenkoliken
flankenschmerzen
Eine Nierenbeckenabgangsenge kann jedoch auch ohne Symptome bleiben und stellt nicht selten einen Zufallsbefund im Rahmen einer Röntgenabklärung dar.
Diagnose:
Mit Hilfe einer Computertomographie sowie einer Nierenfunktionsszintigraphie kann die Diagnose gesichert und der Schweregrad der Enge ermittelt werden.
Behandlungen:
Sollte die Diagnostik eine Funktionseinschränkung der Niere mit Abflussstörung aus dem Nierenbecken zeigen, wird diese operativ behoben, in der Regel mit dem roboterassistierten daVinci-System.
Nierenzysten
Nierenzysten sind mit zunehmendem Alter häufiger zu entdecken und betreffen beispielsweise jede 5. Person über 70 Jahre. Sie können jedoch auch im Rahmen seltener vererbbarer Erkrankungen in grosser Anzahl beide Nieren betreffen. Bei Nierenzysten handelt es sich in der Regel um harmlose flüssigkeitsgefüllte Hohlräume im Nierengewebe. Diese werden meist zufällig im Rahmen einer radiologischen Untersuchung entdeckt.
Symptome:
Flankenschmerzen
Einblutungen oder Entzündung der Niere
Diagnose:
Mit Hilfe von radiologischen Untersuchungen können die Zysten nach der Bosniak-Klassifikation eingeteilt werden. Diese entscheidet darüber, ob die Zysten potenziell als gutartig oder bösartig einzustufen sind. In der Mehrzahl der Fälle müssen die Zysten nicht weiter kontrolliert werden, andere werden nach einem Schema in regelmässigen Abständen kontrolliert.
Behandlungen:
Bei Verdacht auf eine bösartig veränderte Zyste muss diese chirurgisch entfernt werden, was meist mit roboterassistierter Chirurgie möglich ist.
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