Hirsch Jamie S, Drexler Yelena, Bomback Andrew S
Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY.
Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY.
Semin Nephrol. 2014 May;34(3):307-22. doi: 10.1016/j.semnephrol.2014.04.006. Epub 2014 Apr 18.
Although blockade of the renin-angiotensin-aldosterone system with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers has become standard therapy for chronic kidney disease (CKD), renewed interest in the role of aldosterone in mediating the injuries and progressive insults of CKD has highlighted the potential role of treatments targeting the mineralocorticoid receptor (MR). Although salt restriction is an important component of mitigating the profibrotic effects of MR activation, a growing body of literature has shown that MR antagonists, spironolactone and eplerenone, can reduce proteinuria and blood pressure in patients at all stages of CKD. These agents carry a risk of hyperkalemia, but this risk likely can be predicted based on baseline renal function and mitigated using dietary modifications and adjustments of concomitant medications. Data on hard outcomes, such as progression to end-stage renal disease and overall mortality, still are lacking in patients with CKD.
尽管使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂阻断肾素-血管紧张素-醛固酮系统已成为慢性肾脏病（CKD）的标准治疗方法，但醛固酮在介导CKD损伤和进行性损害中的作用再次受到关注，这凸显了靶向盐皮质激素受体（MR）治疗的潜在作用。尽管限制盐摄入是减轻MR激活的促纤维化作用的重要组成部分，但越来越多的文献表明，MR拮抗剂螺内酯和依普利酮可降低CKD各阶段患者的蛋白尿和血压。这些药物有高钾血症风险，但这种风险可能可以根据基线肾功能预测，并通过饮食调整和调整伴随用药来减轻。CKD患者仍缺乏关于诸如进展至终末期肾病和总体死亡率等硬终点的数据。
