特发性膜性肾病研究进展

被引：59

作者：

丁小强

刘春凤

机构：

[1] 复旦大学附属中山医院肾脏科

来源：

中国实用内科杂志 | 2011年 / 31卷 / 02期

关键词：

特发性膜性肾病; 肾病综合征; 免疫抑制剂治疗;

D O I：

暂无

中图分类号：

R692.3 [肾炎];

学科分类号：

摘要：

膜性肾病是引起成人肾病综合征(NS)的最常见病因之一,分为特发性和继发性。特发性膜性肾病(IMN)机制不明,多认为是与免疫机制有关的主动过程,中性内肽酶(NEP)、M型磷脂酶A2受体(PLA2R)、醛糖还原酶(AR)和超氧化物歧化酶(SOD2)原位抗原的发现是近期膜性肾病发病机制的重要进展。IMN临床过程非常多样,随访10年以上的研究表明未经治疗的IMN患者中50%～60%在10～20年内进展至终末期肾病(ESRD),另有30%左右可以自发性缓解。肾功能持续减退及持续严重蛋白尿等是预后不佳的重要指标。低危IMN患者以对症支持治疗为主,若合并高危因素,则应给予特异性治疗。特异性治疗IMN的首选方案是糖皮质激素联合细胞毒类药物,若有禁忌或疗效不佳,还可选择环孢素A、他克莫司或霉酚酸酯(最好联合适当剂量糖皮质激素),也可尝试应用合成促肾上腺皮质激素、Rituximab等药物。总之,治疗应基于患者状况,给予个体化治疗。

引用

页码：108 / 112

页数：5

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