O'Callaghan Christopher Anthony
Département Nuffield de médecine, université d'Oxford, Oxford OX3 9DU, Royaume-Uni.
Nephrol Ther. 2006 Jul;2(3):140-51. doi: 10.1016/j.nephro.2006.04.001. Epub 2006 May 19.
Renal involvement is relatively common in certain systemic autoimmune diseases, but can be clinically silent. Active surveillance is, therefore, essential because the early recognition of renal involvement may influence the extent of renal recovery. Blood pressure control is also essential, regardless of the underlying disease. In systemic lupus erythematosus, therapy usually depends on the renal biopsy findings as not all forms of renal involvement respond in the same way. Typically, for aggressive disease, therapy is with steroids and a cytotoxic agent, usually cyclophosphamide initially and then azathioprine. In systemic vasculitis with renal involvement, a similar approach is adopted, therapy including steroids and cyclophosphamide initially and then steroids and azathioprine. With severe fulminant disease, plasma exchange or pulsed intravenous methylprednisolone is added initially. Scleroderma renal crises are managed by blood pressure control using angiotensin-converting enzyme inhibitors and other agents as required. Dialysis and transplantation can be successful in these conditions.
肾脏受累在某些系统性自身免疫性疾病中相对常见，但在临床上可能没有症状。因此，积极监测至关重要，因为早期识别肾脏受累可能会影响肾脏恢复的程度。无论潜在疾病如何，控制血压也很重要。在系统性红斑狼疮中，治疗通常取决于肾活检结果，因为并非所有形式的肾脏受累都有相同的反应。通常，对于侵袭性疾病，治疗使用类固醇和细胞毒性药物，通常最初使用环磷酰胺，然后使用硫唑嘌呤。在伴有肾脏受累的系统性血管炎中，采用类似的方法，治疗最初包括类固醇和环磷酰胺，然后是类固醇和硫唑嘌呤。对于严重的暴发性疾病，最初会增加血浆置换或静脉注射脉冲式甲基泼尼松龙。硬皮病肾危象通过使用血管紧张素转换酶抑制剂和其他所需药物控制血压来处理。在这些情况下，透析和移植可能会成功。
