特发性膜性肾病伴非肾病范围蛋白尿的研究进展

Research advances of idiopathic membranous nephropathy with non-nephrotic range proteinuria

膜性肾病是肾脏自发性免疫疾病,是肾病综合征最主要的原因之一。然而并非所有的膜性肾病患者都表现为肾病综合征,也有少部分患者在诊断时表现为非肾病范围蛋白尿(24 h尿蛋白定量<3.5 g/d),研究显示这类患者往往有较好的预后。2020版改善全球肾脏病预后组织指南指出对于无进展风险的24 h尿蛋白定量<3.5 g/d的膜性肾病患者无须采取免疫抑制剂治疗,但是也有研究指出大部分非肾病范围蛋白尿患者会在后续病程中发展为肾病综合征,甚至进展迅速,预后不佳。因此早期辨别高危人群并尽早干预对于患者十分重要。本文将结合国内外的文献对膜性肾病伴非肾病范围蛋白尿的研究进展做一综述,以期对临床治疗有所参考。

Membranous nephropathy,an autoimmune kidney disease,is one of the major causes of nephrotic syndrome.However,not all patients with membranous nephropathy present with nephrotic syndrome and some of them develop non-nephrotic range proteinuria(24-hour urine protein quantifica⁃tion<3.5 g/d)at the time of diagnosis.Overall prognosis is decent.The 2020 KDIGO guidelines stated that patients with membranous nephropathy whose 24-h urinary protein level<3.5 g/d without a risk of progression required no therapy of immunosuppressants.However,some studies reported that most pa⁃tients with non-nephrotic proteinuria progressed rapidly into nephrotic syndrome in the subsequent course of disease.Prognosis was poor.Therefore it is imperative to identify high-risk groups early and intervene timely.This review summarized the latest research advances of membranous nephropathy with nonnephrotic proteinuria in both domestic and foreign literatures to provide references for clinical practices.