Zonozi Reza, Niles John L, Cortazar Frank B
Division of Nephrology, Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, 101 Merrimac Street, Boston, MA 02114, USA.
Division of Nephrology, Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, 101 Merrimac Street, Boston, MA 02114, USA.
Rheum Dis Clin North Am. 2018 Nov;44(4):525-543. doi: 10.1016/j.rdc.2018.06.001. Epub 2018 Sep 7.
Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is the most common cause of rapidly progressive glomerulonephritis. ANCAs play an important role in the pathogenesis and diagnosis of AAV. The classic renal lesion in AAV is a pauci-immune necrotizing and crescentic glomerulonephritis. Treatment is divided into 2 phases: (1) induction of remission to eliminate disease activity and (2) maintenance of remission to prevent disease relapse. AAV patients with end-stage renal disease require modification of immunosuppressive strategies and consideration for kidney transplantation. An improved understanding of disease pathogenesis has led to new treatment strategies being tested in clinical trials.
抗中性粒细胞胞浆抗体相关性血管炎(AAV)是快速进展性肾小球肾炎最常见的病因。抗中性粒细胞胞浆抗体(ANCA)在AAV的发病机制和诊断中起重要作用。AAV典型的肾脏病变是少免疫性坏死性新月体性肾小球肾炎。治疗分为两个阶段:(1)诱导缓解以消除疾病活动;(2)维持缓解以防止疾病复发。终末期肾病的AAV患者需要调整免疫抑制策略并考虑进行肾移植。对疾病发病机制的深入了解促使新的治疗策略在临床试验中得到检验。