膜性肾病诊断与治疗新进展

Membranous Nephropathy:A Review on the Diagnosis and Treatment

膜性肾病(membranous nephropathy,MN)是一种独特的肾小球病变,是成人中非糖尿病性特发性肾病综合征的最常见原因。约80%MN病例的病因是特发性的,20%与其他全身性疾病或暴露有关。抗磷脂酶A2受体抗体与特发性MN有关,这一发现可能有助于MN的诊断和预后。目前MN的治疗主要为最佳支持治疗,包括血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂的应用,降脂药和良好的血压控制。免疫抑制剂应用于患有难治性蛋白尿或肾病综合征伴相关并发症的患者,现有证据也支持使用类固醇和烷化剂的组合。本文综述了MN的诊断和治疗的最新研究进展。

Membranous nephropathy(MN)is a unique glomerulonephritis,it is the most common cause of nondiabetic idiopathic nephrotic syndrome in adults.The etiology of approximately 80%MN cases is idiopathic,and 20%is associated with other systemic diseases or exposure.Anti phospholipase A2 receptor antibody is associated with idiopathic MN.This finding may contribute to the diagnosis and prognosis of MN.Current treatment for MN is mainly the best supportive treatment,including the use of angiotensin converting enzyme inhibitors/angiotensinⅡreceptor blockers,lipid-lowering drugs and good blood pressure control.Immunosuppressive agents are used in patients with refractory proteinuria or nephrotic syndrome with associated complications.Available evidence supports the combination of steroids and alkylating agents.This article reviews the latest research progress in the diagnosis and treatment of MN.