Boffa Jean-Jacques, Chauvet Sophie, Mihout Fabrice
Unité Inserm 702, 75020 Paris, France.
Presse Med. 2011 Nov;40(11):1065-73. doi: 10.1016/j.lpm.2011.06.022. Epub 2011 Sep 1.
In chronic kidney disease patients, inexorable renal function decline is reduced by renin-angiotensin system (RAS) blockers. ACE inhibitors and angiotensin receptor blockers decrease blood pressure and proteinuria. Guidelines recommend a reduction of blood pressure to less than 130/80 mmHg and urinary protein excretion below 0.5 g/d. The combined use of a diuretic increases anti-proteinuric effect and blood pressure control of RAS blockers. Drugs as mineralo-corticocoids receptor antagonist and endothelin receptor antagonists reduce further albuminuria in combination with RAS blocker, but side effects need to be precised. Both metabolic acidosis and hyperuricemia represent new therapeutic goals to slow renal function decline in CKD patients. Renal fibrosis treatment and regenerative medicine are stemming and will be important issues for kidney and other organs in the future.
在慢性肾脏病患者中，肾素-血管紧张素系统（RAS）阻滞剂可减缓肾功能的持续下降。ACE抑制剂和血管紧张素受体阻滞剂可降低血压和蛋白尿。指南建议将血压降至130/80 mmHg以下，尿蛋白排泄量低于0.5 g/d。联合使用利尿剂可增强RAS阻滞剂的抗蛋白尿作用并控制血压。盐皮质激素受体拮抗剂和内皮素受体拮抗剂等药物与RAS阻滞剂联合使用可进一步降低蛋白尿，但需要注意副作用。代谢性酸中毒和高尿酸血症都是减缓慢性肾脏病患者肾功能下降的新治疗目标。肾纤维化治疗和再生医学正在兴起，未来将成为肾脏及其他器官的重要问题。
