J Vet Intern Med. 2013 Nov-Dec;27 Suppl 1:S55-9. doi: 10.1111/jvim.12222.
In certain situations, veterinarians must decide whether or not to recommend immunosuppressive therapy for dogs with suspect glomerular disease in the absence of renal biopsy-derived evidence that active immune mechanisms are contributing to glomerular injury. The purpose of this report is to provide guidelines for the use of immunosuppressive drugs under these conditions.
Animals were not used in this study.
Recommendations were developed by a formal consensus method.
Four recommendations were developed and accepted at a high level of consensus (median 92.5% agreement). Renal biopsy should not be performed when contraindications are present or when results will not alter treatment or outcome. Immunosuppressive drugs should not be given when the source of proteinuria is unknown, they are otherwise contraindicated, or a familial nephropathy or amyloidosis is likely. However, they should be considered when dogs are already being given standard therapy and the serum creatinine is >3.0 mg/dL, azotemia is progressive, or hypoalbuminemia is severe. Thorough client communication regarding pros and cons of such treatment as well as close and careful patient monitoring is required.
These recommendations can help guide the decision about renal biopsy in patients with proteinuria as well as the use of immunosuppressive drugs in those patients where the decision was made not to perform renal biopsy.
在某些情况下，兽医必须在没有肾活检证据表明活性免疫机制导致肾小球损伤的情况下，决定是否为疑似肾小球疾病的犬推荐免疫抑制疗法。本报告的目的是为这些情况下使用免疫抑制剂提供指南。
本研究未使用动物。
采用正式共识方法制定建议。
制定并以高共识水平（中位数 92.5%的一致性）接受了四项建议。存在禁忌症或结果不会改变治疗或预后时，不应进行肾活检。当蛋白尿的来源不明、存在其他禁忌症或可能存在家族性肾病或淀粉样变性时，不应给予免疫抑制剂。但是，当犬已经接受标准治疗且血清肌酐 >3.0mg/dL、氮质血症进展或低白蛋白血症严重时，应考虑使用这些药物。需要与客户进行全面沟通，讨论这种治疗的利弊，并密切、仔细地监测患者。
这些建议可以帮助指导有蛋白尿的患者进行肾活检的决策，以及在决定不进行肾活检的情况下使用免疫抑制剂的决策。
