A treatment dilemma in adult immunoglobulin A nephropathy: what is the appropriate target, preservation of kidney function or induction of clinical remission?
A treatment dilemma in adult immunoglobulin A nephropathy: what is the appropriate target, preservation of kidney function or induction of clinical remission?
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DOI：
10.1007/s10157-011-0552-8
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发表时间：
2012-04
影响因子：
2.3
通讯作者：
Miura, Naoto
中科院分区：
文献类型：
--
作者：
Imai, Hirokazu;Miura, Naoto
免疫球蛋白(Ig)肾病是全世界最常见的肾小球肾炎类型。有关其自然病史的数据表明，大约40%的患者在20年后进展为终末期肾功能衰竭。已经提出了多种治疗方法，如抗血小板药物、鱼油、口服强的松龙、静脉注射强的松龙、扁桃体切除术和扁桃体切除术加类固醇脉冲(TSP)。日本的肾病学家面临着关于这种疾病的挑战性问题，例如年度尿路筛查系统(Kenshin)和肾脏活检的有效性，尽管临床证据不足，患者及其家人仍希望接受治疗，以及TSP过度治疗的风险与晚期干预失去一段黄金期的风险。我们回顾了扁桃体摘除、类固醇治疗和日本首次提出的TSP的相关文献，并对IgA肾病的治疗提出了一些看法。
Immunoglobulin (Ig) A nephropathy is the most common type of glomerulonephritis worldwide. Data on its natural history suggest that approximately 40% of patients progress to end-stage renal failure after 20 years. Various therapies such as antiplatelet medication, fish oil, oral prednisolone, intravenous prednisolone, tonsillectomy, and tonsillectomy plus steroid pulse (TSP) have been proposed. Japanese nephrologists face challenging issues regarding this disease, such as the usefulness of the annual urinary screening system (kenshin) and kidney biopsies, the desire of patients and their families for treatment despite insufficient clinical evidence, and the risk of overtreatment with TSP versus the loss of a ‘golden period’ with late intervention. We review the current literature on tonsillectomy, steroid therapy, and TSP, which was first proposed in Japan, and present some perspectives on the treatment of IgA nephropathy.
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