Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD.
Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.
Am J Kidney Dis. 2021 Jun;77(6):969-983. doi: 10.1053/j.ajkd.2020.12.022. Epub 2021 Apr 21.
An estimated 8% to 16% of the world's population has chronic kidney disease, defined by low glomerular filtration rate or albuminuria. Progression of chronic kidney disease is associated with adverse outcomes, including incident kidney failure with replacement therapy, accelerated cardiovascular disease, disability, and mortality. Therefore, slowing kidney function decline is paramount in the management of a patient with chronic kidney disease. Ascertaining the cause of kidney disease is an important first step and may compel specific therapies. Effective approaches that apply to the vast majority of patients with chronic kidney disease include the optimization of blood pressure and blockade of the renin-angiotensin-aldosterone system, particularly if albuminuria is present. Recent studies suggest that sodium/glucose cotransporter 2 inhibitors are highly effective treatments in patients with diabetes and/or albuminuria. For patients with type 2 diabetes, glycemic control is important in preventing the development of microvascular complications, and glucagon-like peptide 1 receptor agonists may help reduce albuminuria levels. Other strategies include correcting metabolic acidosis, maintaining ideal body weight, following diets that are low in sodium and animal protein, and avoiding potential nephrotoxins such as nonsteroidal anti-inflammatories, proton-pump inhibitors, and iodinated contrast.
据估计，全球有 8%至 16%的人口患有慢性肾脏病，其定义为肾小球滤过率低或白蛋白尿。慢性肾脏病的进展与不良结局相关，包括发生需要替代治疗的肾衰竭、加速心血管疾病、残疾和死亡。因此，减缓肾功能下降是慢性肾脏病患者管理的首要任务。确定肾脏病的病因是重要的第一步，可能需要特定的治疗方法。适用于大多数慢性肾脏病患者的有效方法包括优化血压和阻断肾素-血管紧张素-醛固酮系统，特别是如果存在白蛋白尿。最近的研究表明，钠/葡萄糖共转运蛋白 2 抑制剂在糖尿病和/或白蛋白尿患者中是非常有效的治疗方法。对于 2 型糖尿病患者，控制血糖对于预防微血管并发症的发生很重要，胰高血糖素样肽 1 受体激动剂可能有助于降低白蛋白尿水平。其他策略包括纠正代谢性酸中毒、保持理想体重、遵循低钠和低动物蛋白饮食、避免潜在的肾毒物，如非甾体抗炎药、质子泵抑制剂和碘造影剂。
