Uwaezuoke Samuel N, Muoneke Uzoamaka V, Mbanefo Ngozi R
Pediatric Nephrology Firm, Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
Int J Nephrol Renovasc Dis. 2020 Feb 26;13:27-35. doi: 10.2147/IJNRD.S237527. eCollection 2020.
IgA nephropathy (IgAN) is the most prevalent glomerular disease in young adults worldwide, while idiopathic nephrotic syndrome (INS) represents the most frequent manifestation of glomerular disease in childhood. Over the years, studies have speculated about the potential benefits of omega-3 polyunsaturated fatty acids (PUFAs) in improving morbidity in both forms of chronic kidney disease (CKD). The proposed mechanisms of action include reduction of proteinuria and modulation of dyslipidemia. Although in vitro and in vivo experimental studies report the suppressive effect of omega-3 PUFAs on inflammatory pathways linked with the progression of nephropathy, the evidence supporting their beneficial effect in IgAN and INS is still weak. Also, their ability to regulate levels of total cholesterol, low-density lipoprotein-cholesterol (LDL-C), and triglycerides (TG) suggests that they could delay both dyslipidemia-associated nephrotoxicity and atherosclerosis. Most of the clinical trials that were conducted on their therapeutic benefits in IgAN patients reported positive outcomes with low and high doses of omega-3 PUFAs. However, few of the trials noted inconclusive findings, with low-quality evidence suggesting potential improvements in surrogate renal function outcomes. If the beneficial effect of omega-3 PUFAs is predicated on their hypolipidemic action, much higher doses could be used in well-designed randomized-controlled trials (RCTs) to determine if they could produce better renal function outcomes and provide much stronger evidence of their therapeutic benefits in IgAN and INS. However, the current hypothetical mechanisms of action in these forms of CKD also include the effect of omega-3 PUFAs on renal inflammatory pathways and glomerular proteinuria. Perhaps, the unresolved therapeutic efficacy of these fatty acids in IgAN and INS suggests that their exact mechanisms of action are yet to be fully established. In this narrative review, we aim to appraise the current evidence of their potential therapeutic benefits in these diseases.
IgA肾病（IgAN）是全球年轻成年人中最常见的肾小球疾病，而特发性肾病综合征（INS）是儿童期肾小球疾病最常见的表现形式。多年来，研究推测ω-3多不饱和脂肪酸（PUFAs）在改善这两种慢性肾脏病（CKD）的发病率方面可能具有益处。其提出的作用机制包括减少蛋白尿和调节血脂异常。尽管体外和体内实验研究报告了ω-3 PUFAs对与肾病进展相关的炎症途径的抑制作用，但支持其对IgAN和INS有益作用的证据仍然薄弱。此外，它们调节总胆固醇、低密度脂蛋白胆固醇（LDL-C）和甘油三酯（TG）水平的能力表明，它们可以延缓血脂异常相关的肾毒性和动脉粥样硬化。大多数针对IgAN患者进行的关于其治疗益处的临床试验报告了低剂量和高剂量ω-3 PUFAs的阳性结果。然而，很少有试验得出不确定的结果，低质量证据表明替代肾功能结果可能有所改善。如果ω-3 PUFAs的有益作用基于其降血脂作用，那么在精心设计的随机对照试验（RCTs）中可以使用更高的剂量，以确定它们是否能产生更好的肾功能结果，并为其在IgAN和INS中的治疗益处提供更有力的证据。然而，目前这些形式的CKD的假设作用机制还包括ω-3 PUFAs对肾脏炎症途径和肾小球蛋白尿的影响。也许，这些脂肪酸在IgAN和INS中尚未解决的治疗效果表明它们的确切作用机制尚未完全确立。在这篇叙述性综述中，我们旨在评估目前关于它们在这些疾病中潜在治疗益处的证据。
