中国实用内科杂志

中国实用内科杂志 ›› 2012, Vol. 32 ›› Issue (12): 928-931.

• 指南论坛 • 上一篇    下一篇

KDIGO指南解读：特发性膜性肾病治疗

邢昌赢   

  1. 作者单位：南京医科大学第一附属医院肾内科，南京 210029
  • 出版日期:2012-12-01 发布日期:2012-11-22

Treatment of idiopathic membranous nephropathy:interpretation of KDIGO guideline.

XING Chang-ying.   

  1. Department of Nephrology，First Affiliated Hospital of Nanjing Medical University，Jiangsu Province Hospital，Nanjing 210029， China
  • Online:2012-12-01 Published:2012-11-22

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摘要：

特发性膜性肾病(IMN)是成人肾病综合征(NS)中常见的病理类型，其诊断主要是肾脏活检病理检查和排除继发性膜性肾病。改善全球肾脏病预后组织(KDIGO)指南主要从循证医学角度出发，介绍了IMN的规范化治疗。临床表现比较严重者的起始治疗主要是糖皮质激素和(或)烷化剂周期性治疗方案及神经钙调素抑制剂方案，24 h尿蛋白<4 g，没有NS患者采用一般的保守治疗。治疗的主要目的是减少蛋白尿、保护肾功能、减少并发症，提高患者的生活质量。

关键词: 膜性肾病, 特发性, KDIGO指南, 肾病综合征, 糖皮质激素, 烷化剂, 神经钙调素抑制剂

Abstract:

The diagnosis of idiopathic membranous nephrology (IMN)，a common pathological subtype of nephrotic syndrome in adults，has been established via renal biopsy and excluding secondary membranous nephrology.The standardized treatment of IMN has been delineated in the KDIGO guideline，from the perspective of evidencebased medicine.Severe clinical manifestations of IMN should prompt initial treatment with corticosteroids and alkylating agents and (or) calcineurin inhibitors (CNI)，in a monthly altering manner.Patients with 24hour urinary protein of <4 g and absence of nephrotic syndrome may be treated with conservative therapy.This might be achieved by means of reducing proteinuria，protecting renal function，minimizing complications and improving quality of life.

Key words: idiopathic membranous nephropathy, KDIGO guideline, nephritic syndrome, glucocorticosteroid, alkylating agent, calcineurin inhibitor

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