The treatment of glomerular disease--a compromise between the standard and the individual approach.
The treatment of glomerular disease--a compromise between the standard and the individual approach.
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肾小球疾病的治疗——标准方法和个体方法之间的折衷。
DOI：
10.1093/ndt/gfg1041
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
B. Kiperova
中科院分区：
文献类型：
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作者：
B. Kiperova
慢性肾小球肾炎(GN)是终末期肾病(ESRD)的主要病因之一。在早期阶段成功治疗的可能性仍然有限。免疫抑制治疗只在部分患者中导致完全或部分缓解。即使到那时，慢性肾功能不全的非免疫学演变通常也会进入一个渐进的过程。通过对他们的个体评估和管理应用一致的策略，有可能改善GN患者的预后。早期转诊肾内科医生和早期组织学诊断；准确评估损伤类型，即增殖性或非增殖性；活动性和慢性化指数；以及预后指标有助于治疗方法。肾炎管理的目标必须是以最小的治疗副作用抑制疾病。关于免疫抑制疗法，仍有许多悬而未决的问题和争议。需要在有问题的断言和基于证据的协议之间进行精确的区分。治疗所有类型的慢性肾炎的共同任务应该是保护肾脏结构和功能：控制血压，通过药物抑制肾素-血管紧张素系统对肾脏血流动力学和蛋白尿的作用，控制高脂血症和限制纤维化。一些治疗细胞外基质积聚和慢性间质纤维化的新的和有前景的药理学方法正在进行中。
Chronic glomerulonephritis (GN) is one of the leading causes of end-stage renal disease (ESRD). The possibilities for successful treatment in the earliest stages are still limited. Immunosuppressive treatment leads to complete or partial remission only in some patients. Even then, a non-immunological evolution to chronic renal insufficiency often enters a progressive course. By applying a consistent strategy for their individual evaluation and management, it is possible to improve the outcome of patients with GN. The early referral to a nephrologist and an early histomorphological diagnosis; the precise assessment of the type of injury, i.e. proliferative or non-proliferative; the indices of activity and chronicity; and the prognostic indicators are helpful for the therapeutic approach. The goal of the management of GN has to be to suppress the disease with minimum side effects of the treatment. Many unanswered questions and controversies remain concerning the immunosuppressive therapy. A precise distinction is needed between the problematic assertions and evidence-based protocols. A common task for the treatment of all types of chronic GN should be the protection of renal structure and function: control of blood pressure, action on renal haemodynamics and proteinuria via pharmacological inhibition of the renin-angiotensin system, control of hyperlipidaemia and limitation of fibrosis. Some novel and promising pharmacological approaches to extracellular matrix accumulation and chronic interstitial fibrosis are in progress.
DOI：
10.1093/ndt/15.6.799
发表时间：
2000-06
期刊：
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
影响因子：
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作者：
H. Kikuchi;H. Kawachi;Yumi Ito;K. Matsui;Hitonari Nosaka;A. Saito;M. Orikasa;M. Arakawa;F. Shimizu
通讯作者：
H. Kikuchi;H. Kawachi;Yumi Ito;K. Matsui;Hitonari Nosaka;A. Saito;M. Orikasa;M. Arakawa;F. Shimizu