Risler T, Braun N, Erley C M
Sektion Nieren- und Hochdruckkrankheiten, Medizinischen Universitätsklinik Tübingen.
Ther Umsch. 1994 Dec;51(12):807-12.
Primary chronic glomerulonephritis may emerge clinically as acute nephritis, the nephrotic syndrome as well as asymptomatic hematuria and proteinuria. Therapeutic consequences still depend on the morphological diagnosis. In cases of minor proteinuria [< 3,5 g/24 h] immunosuppressive therapy is not superior to symptomatic therapy. In patients with nephrotic syndrome immunosuppressive therapy depends on the morphological diagnosis. Glucocorticoids are the therapy of choice in minimal changes glomerulopathy and should be tried in focal segmental sclerosing glomerulonephritis. Steroids may be tried in pure mesangial as well as in IgA and IgM nephropathy. Especially Ponticelli claims significant therapeutic success in patients with membranous glomerulonephritis treated with Prednisolone and Chlorambucil. Failures and relapses may be treated with Cyclophosphamide, Chlorambucil or Cyclosporin A. Anticoagulants may be advantageous in the therapy of membranoproliferative glomerulonephritis.
原发性慢性肾小球肾炎在临床上可能表现为急性肾炎、肾病综合征以及无症状血尿和蛋白尿。治疗效果仍取决于形态学诊断。对于轻度蛋白尿[<3.5 g/24小时]的病例,免疫抑制治疗并不优于对症治疗。对于肾病综合征患者,免疫抑制治疗取决于形态学诊断。糖皮质激素是微小病变性肾小球病的首选治疗药物,对于局灶节段性肾小球硬化症也可尝试使用。对于单纯系膜增生性以及IgA和IgM肾病也可尝试使用类固醇。特别是庞蒂切利称,用泼尼松龙和苯丁酸氮芥治疗的膜性肾小球肾炎患者有显著的治疗效果。失败和复发的病例可用环磷酰胺、苯丁酸氮芥或环孢素A治疗。抗凝剂在膜增生性肾小球肾炎的治疗中可能有益。