Tomino Yasuhiko
Juntendo University, Tokyo, Japan; Medical Corporation SHOWAKAI, Tokyo, Japan.
Kidney Res Clin Pract. 2016 Dec;35(4):197-203. doi: 10.1016/j.krcp.2016.09.001. Epub 2016 Sep 15.
Chronic kidney disease (CKD) is a worldwide public health problem that affects millions of people from all racial and ethnic groups. Although CKD is not one specific disease, it is a comprehensive syndrome that includes IgA nephropathy. As reported by the Japanese Society of Nephrology, 13.0 million people have CKD. In Japan, major causes of end-stage kidney disease are type 2 diabetic nephropathy, chronic glomerulonephritis, especially IgA nephropathy, hypertensive nephrosclerosis, and polycystic kidney disease. IgA nephropathy is characterized by polymeric IgA1 with aberrant galactosylation (galactose-deficient IgA1) increased in the blood and deposited in the glomerular mesangial areas, as well as partially in the capillary walls. The tonsils are important as one of the responsible regions in this disease. The clarification of the mechanism of galactose-deficient IgA1 production will pave the way for the development of novel therapies. The results of future research are eagerly awaited. At present, the most important therapeutic goals in patients with IgA nephropathy are the control of hypertension, the decrease of urinary protein excretion, and the inhibition of progression to end-stage kidney disease. Several investigators have reported that renin-angiotensin-aldosterone system inhibitors reduce levels of urinary protein excretion and preserve renal function in patients with IgA nephropathy. In Japan, tonsillectomy and steroid pulse therapy are more effective for patients with IgA nephropathy.
慢性肾脏病（CKD）是一个全球性的公共卫生问题，影响着来自所有种族和民族的数百万人。虽然CKD不是一种特定的疾病，但它是一种包括IgA肾病在内的综合综合征。据日本肾脏病学会报告，有1300万人患有CKD。在日本，终末期肾病的主要病因是2型糖尿病肾病、慢性肾小球肾炎，尤其是IgA肾病、高血压性肾硬化和多囊肾病。IgA肾病的特征是血液中异常半乳糖基化的聚合IgA1（缺乏半乳糖的IgA1）增加，并沉积在肾小球系膜区，部分也沉积在毛细血管壁。扁桃体作为该疾病的责任区域之一很重要。阐明缺乏半乳糖的IgA1产生机制将为新型疗法的开发铺平道路。人们热切期待未来研究的结果。目前，IgA肾病患者最重要的治疗目标是控制高血压、减少尿蛋白排泄以及抑制进展至终末期肾病。一些研究人员报告称，肾素 - 血管紧张素 - 醛固酮系统抑制剂可降低IgA肾病患者的尿蛋白排泄水平并保护肾功能。在日本，扁桃体切除术和类固醇冲击疗法对IgA肾病患者更有效。
