Sharaf El Din Usama Abdel Azim, Salem Mona Mansour, Abdulazim Dina Ossama
Usama Abdel Azim Sharaf El Din, Department of Nephrology, School of Medicine, Cairo University, Cairo 11759, Egypt.
World J Nephrol. 2016 Sep 6;5(5):398-417. doi: 10.5527/wjn.v5.i5.398.
Chronic kidney disease (CKD) patients are endangered with the highest mortality rate compared to other chronic diseases. Cardiovascular events account for up to 60% of the fatalities. Cardiovascular calcifications affect most of the CKD patients. Most of this calcification is related to disturbed renal phosphate handling. Fibroblast growth factor 23 and klotho deficiency were incriminated in the pathogenesis of vascular calcification through different mechanisms including their effects on endothelium and arterial wall smooth muscle cells. In addition, deficient klotho gene expression, a constant feature of CKD, promotes vascular pathology and shares in progression of the CKD. The role of gut in the etio-pathogenesis of systemic inflammation and vascular calcification is a newly discovered mechanism. This review will cover the medical history, prevalence, pathogenesis, clinical relevance, different tools used to diagnose, the ideal timing to prevent or to withhold the progression of vascular calcification and the different medications and medical procedures that can help to prolong the survival of CKD patients.
与其他慢性疾病相比，慢性肾脏病（CKD）患者面临着最高的死亡率风险。心血管事件占死亡人数的60%。心血管钙化影响大多数CKD患者。这种钙化大多与肾脏磷酸盐处理紊乱有关。成纤维细胞生长因子23和klotho缺乏通过不同机制，包括对内皮和动脉壁平滑肌细胞的影响，参与了血管钙化的发病过程。此外，klotho基因表达不足是CKD的一个常见特征，它促进血管病变并参与CKD的进展。肠道在全身炎症和血管钙化的病因发病机制中的作用是一个新发现的机制。本综述将涵盖病史、患病率、发病机制、临床相关性、用于诊断的不同工具、预防或阻止血管钙化进展的理想时机，以及有助于延长CKD患者生存期的不同药物和医疗程序。
