肾性蛋白尿非特异性治疗进展

The Progress of Nephrogenous Albuminuria Using Nonspecific Therapy

肾脏疾病蛋白尿的水平与慢性肾衰竭进展的速度密切相关。至今研究表明,血管紧张素转换酶抑制剂(ACEI)可降低蛋白尿,延缓肾功能恶化的进展,推荐治疗剂量为血压耐受量,对尿蛋白<1g较>1g者疗效更佳。血管紧张素Ⅱ受体拮抗剂(ARB),也具有降低蛋白尿的作用,大剂量优于常规剂量。ACEI和ARB联合应用比单个药物大剂量应用有更强的降尿蛋白作用。非二氢吡啶类钙通道阻滞剂也可减少糖尿病肾病蛋白尿,是否确有与降压作用无关的肾脏保护作用,尚未取得一致意见。前列腺素E1及抗醛固酮治疗都有一定的疗效。他汀类药物降低蛋白尿的程度究竟如何还需进一步观察。羟苯磺酸钙可降低糖尿病肾病尿白蛋白的排泄,降低非糖尿病肾病蛋白尿尚处于观察阶段。

The level of renal proteinuria has close correlation with the progress rate of chronic renal failure. Studies explained that angiotensin converting enzyme inhibitor （ACEI） could reduce proteinuria and postpone the progress of renal failure. It recommended that therapeutic dose is blood pressure tolerant dose, and the effect of proteinuria below 1 gram better than that of over1 gram. Angiotensin Ⅱ receptor antagonist （ARB） can also decrease proteinuria excretion,which big dose is superior to routine dose.Combined use of ACEI and ARB has stronger effect than big dose of single drug. Non-dihydrepyridine calcium antagonists can reduce proteinuria of diabetic nephropathy, but whether it has renal protection nothing with decompression effect or not still have not gotten coincidence opinion. Prostaglandin Eland anti-aldosterone drugs all have definitive effect. How ststins could decrease the degree of proteinuria need further observation. Calcium dobesilate may reduce albuminuria of diabetic nephropathy, but whether it decrease proteinuria excretion of non-diabetic nephropathy or not is in observing stage.