Wapstra F H, Navis G, de Jong P E, de Zeeuw D
Groningen Institute of Drug Studies, (GIDS), Department of Medicine, State University, The Netherlands.
Exp Nephrol. 1996;4 Suppl 1:47-52.
In chronic renal disease, the severity of proteinuria is associated with the rate of renal function loss. Proteinuria, therefore, was postulated to play a role in the final common pathway of chronic renal function loss. If so, reduction of proteinuria would improve long-term renal outcome. Improvement of long-term renal function outcome has been obtained in several intervention trials; in these studies; regimens providing better renoprotection were associated with more effective reduction of poteinuria than control regimens. As the reduction of proteinuria is mostly associated with a fall in blood pressure, however, it is difficult to delineate the respective roles of the lowering of blood pressure and of proteinuria. Interestingly, the initial reduction of proteinuria (but not of blood pressure) by antihypertensive treatment appears to predict long-term renal outcome in man as well as in experimental renal disease. This suggests that an intervention strategy aimed not only at the normalization of blood pressure, but also specifically at elimination of proteinuria, might be able to improve long-term renal outcome in proteinuric patients. If so, this would provide further evidence in support of the hypothesis that proteinuria is causally involved in the progression of long-term renal function loss.
在慢性肾脏疾病中，蛋白尿的严重程度与肾功能丧失的速率相关。因此，蛋白尿被假定在慢性肾功能丧失的最终共同途径中起作用。如果是这样，降低蛋白尿将改善长期肾脏结局。在几项干预试验中已经取得了长期肾功能结局的改善；在这些研究中，提供更好肾脏保护作用的治疗方案与比对照方案更有效地降低蛋白尿相关。然而，由于蛋白尿的降低大多与血压下降相关，因此难以区分降低血压和降低蛋白尿各自的作用。有趣的是，抗高血压治疗最初降低蛋白尿（而非血压）似乎可预测人类以及实验性肾脏疾病的长期肾脏结局。这表明，一种不仅旨在使血压正常化，而且特别旨在消除蛋白尿的干预策略，可能能够改善蛋白尿患者的长期肾脏结局。如果是这样，这将为支持蛋白尿因果性参与长期肾功能丧失进展这一假说提供进一步证据。
