IgA肾病治疗的思考  

Thoughts on treatment of IgA nephropathy

作　　者：彭佑铭[1] 

机构地区：[1]中南大学湘雅二医院肾内科,长沙410011

出　　处：《中华肾病研究电子杂志》2016年第5期195-198,共4页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：国家自然科学基金资助项目(81373227;81470947;81400721)

摘　　要：IgA肾病是我国最常见的原发性肾小球疾病。主要以IgA免疫球蛋白沉积于肾小球为病理特征;以血尿、蛋白尿、高血压和肾功能损害为主要临床表现。每次血尿和(或)蛋白尿发作是肾小球损伤的标志,如不有效进行干预,可逐渐出现肾功能损害。控制血尿和(或)蛋白尿,降低尿检异常发生的频率,是治疗原发性IgA肾病及防止肾脏慢性化损伤的关键。ACEI/ARB在减少IgA肾病患者的蛋白尿、保护残存肾功能、延缓其进展为终末期肾病等方面优于其他降压药。IgA肾病如有较多新月体形成、明显血尿和蛋白尿,可考虑使用糖皮质激素和(或)与免疫抑制剂。由于IgA肾病是一个慢性化过程,长期随访对改善该病的预后显得尤为重要。IgA nephropathy （IgAN） is the most common primary glomerular disease in China. It is pathologically characterized by IgA immunoglobulin deposit in glomeruli, with hematuria, proteinuria, hypertension, and renal dysfunction as the major clinical manifestations. Each attack of hematuria and/or proteinuria is the sign of glomerular injury. Without effective intervention, it gradually progresses to renal dysfunction. Controlling hematuria and/or proteinuria, and reducing frequency of recurrent urine abnormalities are the key to treat IgAN and prevent chronic renal injury. ACEI and ARB are superior to other antihypertensive drugs in reducing proteinuria, protecting residual renal function, and delaying the progression of IgAN to ESRD. Combined use of corticosteroids and / or immunosuppressive agents may be considered for treatment of IgAN with substantial crescents, hematuria, and proteinuria. As IgAN has a chronic process, long-term follow-up appears especially important to improve the prognosis.

关 键 词：IGA肾病 黏膜免疫 血尿 蛋白尿 治疗 

分 类 号：R692.31[医药卫生—泌尿科学]