糖皮质激素治疗肾脏疾病临床经验

Use of glucocorticoids in the treatment of kidney diseases

多数肾脏疾病的发生、发展与免疫异常及炎症反应有关,糖皮质激素具有强大的抗炎和免疫抑制作用,是治疗肾病综合征、进展期肾病或病理有活动性病变的免疫介导性肾脏疾病的主要药物。但肾脏病应用激素治疗一般起始剂量大、疗程较长,使用不当会造成严重的不良反应。因此,应参照国内外关于肾脏病治疗的最新指南规范使用,严格掌握其适应证、疗效判断标准及影响因素,熟悉激素引起的副反应,坚持个体化治疗,避免盲目追求某些实验室指标(如蛋白尿)的减少而过度使用,在取得肾脏病临床缓解的同时尽可能减少不良反应。

The initiation and progression of many renal diseases are associated with abnormal immune and inflammatory re- actions. Glucocorticoids have powerful anti-inflammatory and immunosuppressive effects, which plays an important role in the treatment of immune-mediated kidney diseases,including nephrotic syndrome, progressive glomerulonephritis or disorders with active pathological lesions. Treatment of kidney diseases with glucocorticoids generally starts at high doses and maintain for a long course. Improper use can cause serious adverse reactions. Therefore, renal physicians should prescribe medication based on the latest clinical guidelines to perform standard use with definite indications. Doctors should be familiar with treat- ment efficacy, its affecting factors, and hormone-induced side effects. Individualized treatment is advocated to avoid the ex- cessive use of glucocorticoids. Clinical remission of renal diseases should be achieved with less adverse reactions during treatment with glucocorticoids.