Waldman Meryl, Austin Howard A
Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
Nat Rev Nephrol. 2009 Aug;5(8):469-79. doi: 10.1038/nrneph.2009.101. Epub 2009 Jul 7.
Optimum treatment of idiopathic membranous nephropathy is both controversial and challenging. The most extensively studied and frequently used immunosuppressive regimens for this disease comprise alkylating agents plus corticosteroids or ciclosporin. All of these treatment options have inherent problems: they are not effective in all patients, partial-rather than complete-remissions are common, adverse effects are worrisome, and relapses after treatment cessation remain problematic. Alternative immunosuppressive agents have been tested in an effort to overcome these unresolved issues. This paper reviews the available evidence regarding both established and new agents for the treatment of patients with idiopathic membranous nephropathy, with an emphasis on the results of the most recent clinical trials.
特发性膜性肾病的最佳治疗方案既存在争议，又具有挑战性。针对该疾病，研究最广泛且使用最频繁的免疫抑制方案包括烷化剂加皮质类固醇或环孢素。所有这些治疗方案都存在固有问题：它们并非对所有患者都有效，部分缓解而非完全缓解很常见，不良反应令人担忧，且停药后复发问题依然存在。人们已对其他免疫抑制剂进行了试验，试图克服这些尚未解决的问题。本文回顾了有关治疗特发性膜性肾病的既有药物和新药物的现有证据，重点是最新临床试验的结果。
