Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Anichstraße 35, Innsbruck, 6020, Austria.
BMC Med. 2013 Apr 4;11:95. doi: 10.1186/1741-7015-11-95.
Connective tissue diseases (CTDs) are a heterogeneous group of disorders that share certain clinical presentations and a disturbed immunoregulation, leading to autoantibody production. Subclinical or overt renal manifestations are frequently observed and complicate the clinical course of CTDs. Alterations of kidney function in Sjögren syndrome, systemic scleroderma (SSc), auto-immune myopathies (dermatomyositis and polymyositis), systemic lupus erythematosus (SLE), antiphospholipid syndrome nephropathy (APSN) as well as rheumatoid arthritis (RA) are frequently present and physicians should be aware of that.In SLE, renal prognosis significantly improved based on specific classification and treatment strategies adjusted to kidney biopsy findings. Patients with scleroderma renal crisis (SRC), which is usually characterized by severe hypertension, progressive decline of renal function and thrombotic microangiopathy, show a significant benefit of early angiotensin-converting-enzyme (ACE) inhibitor use in particular and strict blood pressure control in general. Treatment of the underlying autoimmune disorder or discontinuation of specific therapeutic agents improves kidney function in most patients with Sjögren syndrome, auto-immune myopathies, APSN and RA.In this review we focus on impairment of renal function in relation to underlying disease or adverse drug effects and implications on treatment decisions.
结缔组织疾病（CTD）是一组异质性疾病，具有某些共同的临床表现和免疫调节紊乱，导致自身抗体产生。亚临床或显性肾脏表现经常观察到，并使 CTD 的临床病程复杂化。干燥综合征、系统性硬皮病（SSc）、自身免疫性肌病（皮肌炎和多发性肌炎）、系统性红斑狼疮（SLE）、抗磷脂综合征肾病（APSN）以及类风湿关节炎（RA）患者的肾功能改变很常见，医生应该意识到这一点。在 SLE 中，根据特定的分类和针对肾活检结果调整的治疗策略，肾脏预后显著改善。硬皮病肾危象（SRC）患者通常表现为严重高血压、肾功能进行性下降和血栓性微血管病，早期使用血管紧张素转换酶（ACE）抑制剂特别是一般严格控制血压有显著益处。治疗潜在的自身免疫性疾病或停用特定治疗药物可改善大多数干燥综合征、自身免疫性肌病、APSN 和 RA 患者的肾功能。在这篇综述中，我们重点关注与潜在疾病或药物不良反应相关的肾功能损害及其对治疗决策的影响。
