Cravedi Paolo, Ruggenenti Piero, Remuzzi Giuseppe
Mario Negri Institute for Pharmacological Research, Negri Bergamo Laboratories, Via Gavazzeni, Bergamo, Italy.
Curr Hypertens Rep. 2007 Apr;9(2):160-5. doi: 10.1007/s11906-007-0028-0.
In diabetic and nondiabetic chronic nephropathies, high blood pressure and urinary loss of proteins represent major determinants of progressive renal function decline. Reducing blood pressure with drugs that inhibit the renin-angiotensin system also lowers glomerular hypertension and ameliorates glomerular sieving properties, thus reducing proteinuria. Reducing urinary protein levels with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor antagonists (ARA) limits renal function decline to the point that remission of disease and regression of renal lesions have been observed in experimental animals and in humans. This therapy, however, may not be effective in all patients. For patients who do not achieve complete remission of proteinuria, renoprotective treatment should include intensified blood pressure control (and metabolic control in diabetes) and amelioration of dyslipidemia. Early intervention, before progressive glomerulosclerosis and scarring is initiated by increased protein traffic, may be important to maximize reno- and cardioprotection, especially in diabetes.
在糖尿病和非糖尿病慢性肾病中，高血压和蛋白尿是肾功能进行性下降的主要决定因素。使用抑制肾素-血管紧张素系统的药物降低血压，也可降低肾小球高压并改善肾小球滤过特性，从而减少蛋白尿。使用血管紧张素转换酶抑制剂（ACEi）或血管紧张素II受体拮抗剂（ARA）降低尿蛋白水平，可限制肾功能下降，在实验动物和人类中已观察到疾病缓解和肾损伤消退。然而，这种疗法可能并非对所有患者都有效。对于蛋白尿未完全缓解的患者，肾脏保护治疗应包括强化血压控制（以及糖尿病中的代谢控制）和改善血脂异常。在蛋白质转运增加引发进行性肾小球硬化和瘢痕形成之前进行早期干预，对于最大化肾脏和心脏保护可能很重要，尤其是在糖尿病中。
