Ponticelli C, Passerini P
Division of Nephrology and Dialysis, Istituto Scientifico Ospedale Maggiore, Milano, Italy.
Clin Nephrol. 1991;35 Suppl 1:S16-21.
This article is a review of the results of corticosteroid and immunosuppressive treatment in adults with idiopathic nephrotic syndrome. Adults with minimal-change nephropathy usually require a prolonged administration of corticosteroids to achieve remission which, in itself, carries the risk of severe and even life-threatening complications. Therefore, intravenous high-dose steroid pulses, alternate-day prednisone, short courses with cytotoxic agents and long-term administration of azathioprine have been suggested as alternatives to the classical prolonged corticotherapy. While most patients with focal-segmental glomerulosclerosis do not respond to short-term prednisone, almost half of the patients with nephrotic syndrome will attain remission with a more prolonged administration of corticosteroids and/or cytotoxic agents. A six-month course of methylprednisolone and chlorambucil preserves renal function and reduces the proteinuria in many patients with membranous nephropathy, even in the presence of initial renal insufficiency. Thus, there is growing evidence that corticosteroids and/or immunosuppressive agents can favorably alter the natural course of disease in many patients with idiopathic glomerulonephritis. However, these agents have a low therapeutic index. Further studies are needed to find more effective and less toxic treatment approaches in patients with primary glomerulonephritis.
本文综述了成人特发性肾病综合征的皮质类固醇和免疫抑制治疗结果。微小病变型肾病成人患者通常需要长期使用皮质类固醇以实现缓解，而这本身就存在严重甚至危及生命并发症的风险。因此，有人建议静脉注射大剂量类固醇脉冲、隔日服用泼尼松、短期使用细胞毒性药物以及长期服用硫唑嘌呤，作为传统长期皮质激素治疗的替代方案。虽然大多数局灶节段性肾小球硬化患者对短期泼尼松治疗无反应，但几乎一半的肾病综合征患者通过更长时间使用皮质类固醇和/或细胞毒性药物可实现缓解。对于许多膜性肾病患者，即使存在初始肾功能不全，六个月的甲泼尼龙和苯丁酸氮芥疗程也能保留肾功能并减少蛋白尿。因此，越来越多的证据表明，皮质类固醇和/或免疫抑制剂可以有利地改变许多特发性肾小球肾炎患者的疾病自然进程。然而，这些药物的治疗指数较低。需要进一步研究以找到更有效且毒性更小的原发性肾小球肾炎患者治疗方法。
