KDIGO指南解读：血管炎肾损伤治疗  

Treatment of vasculitis-induced renal injury:interpretation of KDIGO guideline

作　　者：陈旻[1] 

机构地区：[1]北京大学第一医院肾内科,北京100034

出　　处：《中国实用内科杂志》2012年第12期932-934,共3页Chinese Journal of Practical Internal Medicine

摘　　要：原发性小血管炎是一组累及全身多系统特别是肾脏和肺脏的自身免疫性疾病,根据KDIGO指南,其治疗主要分为初始治疗和维持治疗,初始治疗是应用糖皮质激素联合细胞毒性药物(特别是环磷酰胺或利妥昔单抗),对于重症患者应采取必要的抢救措施,包括大剂量甲泼尼龙冲击和血浆置换治疗。维持缓解主要是长期应用免疫抑制剂治疗,特别是硫唑嘌呤或吗替麦考酚酯等。复发的患者可以根据其复发的程度适当增加糖皮质激素和(或)免疫抑制剂的剂量,甚至重新按照初始的诱导治疗方案进行治疗。Summary ： Primary small vessel vasculitis has been pathologically classified as a spectrum of autoimmune diseases involving the kidneys and lungs. Treatment of primary small vessel vasculitis, based on the KDIGO guideline, included initial and ma intenance therapy. Initial treatment consisted mainly of cortieosteroids and cytotoxic medications （ esp. cyclophosphamide, rituximab） and may involve highdose methylprednisolone and plasma exchange therapy as an emergent surrogate in severe cases,while the maintenance therapy mostly included the immunosuppressants, typically, azathioprine and mycophenolate mofetil. The treatment could be initiated by increasing the doses of corticosteroids or innnunosuppressants according to the severity of relapse and, if warranted, repeat the induction protocol for initial therapy.

关 键 词：小血管炎 抗中性粒细胞胞浆抗体 免疫抑制剂 糖皮质激素 

分 类 号：R543[医药卫生—心血管疾病]