Albuminuria Is an Appropriate Therapeutic Target in Patients with CKD: The Pro View
Albuminuria Is an Appropriate Therapeutic Target in Patients with CKD: The Pro View
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DOI：
10.2215/cjn.11511114
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发表时间：
2015-06-01
影响因子：
9.8
通讯作者：
Gansevoort, Ron T.
中科院分区：
文献类型：
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作者：
Heerspink, Hiddo J. Lambers;Gansevoort, Ron T.
随着时间的推移，蛋白尿水平升高与进行性肾功能丧失的风险增加有关。这种关联存在于各种病理生理条件下，包括糖尿病肾病、高血压性肾病和各种原发肾脏疾病，但也存在于一般健康人群中。新的数据报道，蛋白尿升高通过激活促炎介质导致肾小管间质损伤，最终导致肾功能进行性下降。目前，已有多种药物可用于降低肾脏疾病患者的GFR缺失率。众所周知的是肾素-血管紧张素-醛固酮系统抑制剂，但也有其他药物和干预措施，如强化血糖控制、抗炎药(己酮可可碱)或低蛋白饮食。这些干预措施有一个超出其最初目标的额外效果，即降低蛋白尿。临床试验的分析表明，在这些药物治疗的头几个月里观察到的蛋白尿的减少与长期肾脏保护的程度有关：蛋白尿的初始减少越大，治疗期间发生终末期肾病的风险就越低。此外，在接受治疗的患者中，残余蛋白尿再次成为肾脏疾病进展的最大风险标记物。这些观察综合起来提供了一个强有力的论据，即蛋白尿是CKD患者合适的治疗靶点。
The presence of elevated levels of albuminuria is associated with an increased risk of progressive renal function loss over time. This association is found in various pathophysiological conditions, including diabetic nephropathy, hypertensive nephropathy, and various primary renal diseases, but also, the general, otherwise healthy population. Emerging data report that elevated albuminuria causes tubulointerstitial damage through activation of proinflammatory mediators, which ultimately leads to a progressive decline in renal function. Nowadays, various drugs are available that decrease the rate of GFR loss in patients with kidney disease. Well known are renin-angiotensin-aldosterone system inhibitors, but there are also other drugs and interventions, like intensive glucose control, anti-inflammatory agents (pentoxifylline), or a low-protein diet. These interventions have an additional effect beyond their original target, namely lowering albuminuria. Analyses from clinical trials show that the reduction in albuminuria observed during the first months of treatment with these drugs correlates with the degree of long-term renal protection: the larger the initial reduction in albuminuria, the lower the risk of ESRD during treatment. In addition, in treated patients, residual albuminuria is again the strongest risk marker for renal disease progression. These observations combined provide a strong argument that albuminuria is an appropriate therapeutic target in patients with CKD.