结节病肾损害的研究进展

Progress in research of renal sarcoidosis

结节病(sarcoidosis)是一种病因和发病机制不明的系统性肉芽肿性疾病,可累及肺、淋巴结、皮肤、肾、眼等多个脏器,其中肾脏受累发生率较高。结节病肾损害(RS)的主要临床表现为肾小管功能障碍、高钙血症相关性肾脏疾病;病理学特征是非干酪坏死性上皮细胞样肉芽肿的积聚、间质性肾炎的形成。结节病肾损害起病隐匿,临床表现无特异性,诊断缺乏统一标准,易被临床医师忽视,严重肾脏受累者可引起急、慢性肾衰竭,甚至进展至终末期肾脏病。早期诊断和及时应用糖皮质激素或其他免疫抑制剂治疗可改善预后。本文就结节病肾损害的流行病学、发病机制、临床表现、治疗及预后做一综述,为结节病肾损害临床管理提供新的思路。

Sarcoidosis is a systemic granulomatous disease with unknown etiology and pathogenesis,which can affect multiple organs such as the lungs,lymph nodes,skin,kidneys,and eyes,among which the incidence of kidney involvement is relatively high.The main clinical manifestations of renal sarcoidosis are renal tubular dysfunction and hypercalcemia related renal disease.The pathological characteristics are accumulation of noncaseating necrotizing epithelioid granuloma and interstitial nephritis.Since renal sarcoidosis has an insidious onset and non-specific clinical manifestations and their is a lack of unified diagnostic standards,it is easy to be ignored by clinicians.Severe kidney involvement can lead to acute or chronic renal failure,and even progress to end-stage renal disease.Early diagnosis and timely application of glucocorticoids or immunosuppressants can improve the prognosis.This article reviews the epidemiology,pathogenesis,clinical manifestations,treatment,and prognosis of renal sarcoidosis,with an aim to provide a new idea for clinical management of renal sarcoidosis.