The non-immunosuppressive management of childhood nephrotic syndrome.
The non-immunosuppressive management of childhood nephrotic syndrome.
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DOI：
10.1007/s00467-015-3241-0
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发表时间：
2016-09
期刊：
影响因子：
--
通讯作者：
Webb NJ
中科院分区：
文献类型：
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作者：
McCaffrey J;Lennon R;Webb NJ
特发性肾病综合征（INS）是儿科人群中最常见的肾脏疾病之一，并与严重并发症相关，包括感染和血栓形成。高比例的儿童在成年前进入持续缓解期，因此治疗必须减轻儿童期并发症，同时最大限度地减少对健康的长期风险。在这里，我们讨论了INS的主要并发症，并总结了现有的证据和指导，以帮助临床医生确定适当的治疗INS儿童在他们的照顾。此外，我们强调了尚未就适当管理达成共识的领域。在这篇综述中，我们详细介绍了常规预防性抗菌药物和抗血栓治疗在INS中不必要的原因，并强调水肿的保守治疗。当需要药物干预治疗水肿时，我们提供指导以帮助临床医生确定适当的治疗方法。此外，我们还讨论了肥胖和生长，骨折风险，血脂异常和甲状腺功能障碍与INS。在适当的情况下，我们描述了最近的研究进展如何确定潜在的新的治疗目标。
Idiopathic nephrotic syndrome (INS) is one of the most common renal diseases found in the paediatric population and is associated with significant complications, including infection and thrombosis. A high proportion of children enter sustained remission before adulthood, and therapy must therefore mitigate the childhood complications, while minimising the long-term risk to health. Here we address the main complications of INS and summarise the available evidence and guidance to aid the clinician in determining the appropriate treatment for children with INS under their care. Additionally, we highlight areas where no consensus regarding appropriate management has been reached. In this review, we detail the reasons why routine prophylactic antimicrobial and antithrombotic therapy are not warranted in INS and emphasise the conservative management of oedema. When pharmacological intervention is required for the treatment of oedema, we provide guidance to aid the clinician in determining the appropriate therapy. Additionally, we discuss obesity and growth, fracture risk, dyslipidaemia and thyroid dysfunction associated with INS. Where appropriate, we describe how recent developments in research have identified potential novel therapeutic targets.