Loghman-Adham M
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City.
J Lab Clin Med. 1993 Jul;122(1):16-26.
Dietary phosphorus restriction can prevent the progression of renal failure in subtotally nephrectomized rats or in rats with nephrotoxic serum nephritis, independent of protein and caloric intake. Conversely, diets high in phosphorus content result in a more rapid deterioration of renal function. The results are less compelling in indicating that phosphorus restriction can slow the progression of renal failure in the clinical setting. The toxicity of phosphate appears to be related to induction of calcium phosphate precipitation, resulting in tubulointerstitial disease. Most studies of prevention of renal calcification have addressed a single pathway in the development of nephrocalcinosis. These include inhibitors of calcium phosphate precipitation, calcium channel blockers, or an inhibitor of PTH secretion. All of these studies have shown a beneficial effect in preserving renal function. It is possible that a combination of these agents, started early in the course of CRF, may have an additive effect in preventing the progression to ESRD. The discussion of other factors associated with progression of renal failure is beyond the scope of this review. It is obvious that dietary protein restriction, treatment of systemic and intraglomerular hypertension and lipid abnormalities, and prevention of iron overload, all play roles in the preservation of renal function in CRF.
饮食中限制磷的摄入可以预防肾大部切除大鼠或患有肾毒性血清性肾炎大鼠的肾衰竭进展，这与蛋白质和热量摄入无关。相反，高磷饮食会导致肾功能更快恶化。在临床环境中，关于磷限制能减缓肾衰竭进展的证据并不那么令人信服。磷酸盐的毒性似乎与磷酸钙沉淀的诱导有关，从而导致肾小管间质疾病。大多数预防肾钙化的研究都针对肾钙质沉着症发展过程中的单一途径。这些途径包括磷酸钙沉淀抑制剂、钙通道阻滞剂或甲状旁腺激素分泌抑制剂。所有这些研究都表明在保护肾功能方面有有益作用。在慢性肾衰竭病程早期开始联合使用这些药物，可能对预防进展为终末期肾病有相加作用。本文综述范围不涉及与肾衰竭进展相关的其他因素的讨论。显然，饮食中限制蛋白质摄入、治疗全身性和肾小球内高血压及脂质异常以及预防铁过载，在慢性肾衰竭患者肾功能的保护中均发挥作用。
