狼疮肾炎相关性慢性肾病-动脉网

Lupus nephritis-related chronic kidney disease

Nature 等信源发布 2024-09-24 00:25

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AbstractLupus nephritis is a common complication of systemic lupus erythematosus (SLE) and a determinant of overall morbidity and mortality, as lupus nephritis-related chronic kidney disease (CKD) drives cardiovascular disease and secondary immunodeficiency. Two lines of action are required to prevent the progression of lupus nephritis-related CKD: suppression of autoimmune SLE activity, which is a risk factor for immunopathology-related irreversible kidney injury, and management of non-immune risk factors that contribute to CKD progression.

摘要狼疮性肾炎是系统性红斑狼疮（SLE）的常见并发症，是总体发病率和死亡率的决定因素，因为狼疮性肾炎相关的慢性肾病（CKD）会导致心血管疾病和继发性免疫缺陷。预防狼疮性肾炎相关CKD的进展需要两条行动路线：抑制自身免疫性SLE活性，这是免疫病理学相关不可逆肾损伤的危险因素，以及管理导致CKD进展的非免疫危险因素。

As each episode or relapse of active lupus nephritis implicates CKD progression, preventing flares of lupus nephritis is a key treatment target. Non-immune risk factors of CKD mostly include causes of nephron hyperfiltration, such as obesity, hypertension, sodium- or protein-rich diets and type 2 diabetes mellitus, as well as pregnancy.

由于活动性狼疮性肾炎的每次发作或复发都与CKD的进展有关，因此预防狼疮性肾炎的发作是关键的治疗目标。CKD的非免疫危险因素主要包括肾单位超滤的原因，如肥胖，高血压，富含钠或蛋白质的饮食和2型糖尿病，以及怀孕。

Nephrotoxic agents and smoking also drive kidney cell loss. Intrinsic risk factors for CKD progression include poor nephron endowment because of prematurity at birth, nephropathic genetic variants, ageing, male sex and previous or concomitant kidney diseases. Care for lupus nephritis involves the control of all modifiable risk factors of CKD progression.

肾毒性药物和吸烟也会导致肾细胞丢失。CKD进展的内在危险因素包括由于出生时早产，肾病遗传变异，衰老，男性以及先前或伴随的肾脏疾病而导致的肾单位禀赋差。狼疮性肾炎的护理涉及控制CKD进展的所有可改变的危险因素。

In addition, remnant nephron overload can be reduced using early dual therapy with inhibitors of the renin–angiotensin system and sodium–glucose transporter-2, whereas further renoprotective drug interventions are underway. As patients with lupus nephritis are at risk of CKD progression, they would all benefit from interdisciplinary care to minimize the risk of kidney failure, cardiovascular disease and infections.Key points.

此外，使用肾素-血管紧张素系统和钠-葡萄糖转运蛋白-2抑制剂的早期双重治疗可以减少残余肾单位超负荷，而进一步的肾脏保护药物干预正在进行中。由于狼疮性肾炎患者有CKD进展的风险，因此他们都将受益于跨学科护理，以最大程度地降低肾衰竭，心血管疾病和感染的风险。关键点。

All patients with lupus nephritis have chronic kidney disease (CKD), which increases the risk of cardiovascular manifestations and secondary immunodeficiency.

所有狼疮性肾炎患者都患有慢性肾病（CKD），这会增加心血管表现和继发性免疫缺陷的风险。

To minimize the risk of CKD progression, both immune and non-immune factors should be addressed.

为了最大程度地降低CKD进展的风险，应解决免疫和非免疫因素。

Suppressing autoimmune activity of systemic lupus erythematosus reduces repeated episodes of inflammatory kidney injury.

抑制系统性红斑狼疮的自身免疫活性可减少炎症性肾损伤的反复发作。

Assessment of non-modifiable non-immune risk factors for CKD progression and cardiovascular events, including genetic susceptibilities, poor nephron endowment because of preterm birth, previous kidney injuries or ageing, can help to tailor the monitoring and management of lupus nephritis-associated CKD to patient-specific conditions..

评估CKD进展和心血管事件的不可改变的非免疫危险因素，包括遗传易感性，早产导致的肾单位禀赋差，既往肾损伤或衰老，可以帮助根据患者的具体情况调整狼疮性肾炎相关CKD的监测和管理。。

Management of modifiable non-immune risk factors, such as obesity or weight gain, type 2 diabetes mellitus, arterial hypertension, sodium- and protein-rich diets, exposure to smoking and nephrotoxic agents, can further help to minimize CKD progression and risk of cardiovascular disease.

管理可改变的非免疫风险因素，如肥胖或体重增加，2型糖尿病，动脉高血压，富含钠和蛋白质的饮食，暴露于吸烟和肾毒性药物，可以进一步帮助减少CKD进展和心血管疾病的风险。

Therapy with an inhibitor of the renin–angiotensin system at the maximal tolerated dose and potentially combined with an SGLT2 inhibitor might benefit patients with persistent proteinuria and a reduced estimated glomerular filtration rate.

以最大耐受剂量使用肾素-血管紧张素系统抑制剂并可能与SGLT2抑制剂联合治疗可能会使持续性蛋白尿和估计肾小球滤过率降低的患者受益。

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Fig. 1: Fundamental concepts about kidney reserve and healthy kidney ageing versus chronic kidney disease.Fig. 2: Immune mechanisms of lupus nephritis-related chronic kidney disease.Fig. 3: Non-immune mechanisms of lupus nephritis-related chronic kidney disease.Fig. 4: Management of lupus nephritis-related chronic kidney disease..

图1：关于肾脏储备和健康肾脏衰老与慢性肾脏疾病的基本概念。图2：狼疮性肾炎相关慢性肾脏疾病的免疫机制。图3：狼疮性肾炎相关慢性肾脏疾病的非免疫机制。图4：狼疮性肾炎相关慢性肾脏疾病的治疗。。

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Download referencesAcknowledgementsH.-J.A. was supported by the Deutsche Forschungsgemeinschaft AN372/29-1 and 30-1.Author informationAuthors and AffiliationsDepartment of Medicine IV, Hospital of LMU Munich, Munich, GermanyJulia Lichtnekert & Hans-Joachim AndersAuthorsJulia LichtnekertView author publicationsYou can also search for this author in.

下载referencesAcknowledgementsH-J、 A.得到了Deutsche Forschungsgemeinschaft AN372/29-1和30-1的支持。作者信息作者和附属机构慕尼黑LMU慕尼黑医院医学IV部，德国JulianLichtnekert＆Hans Joachim AndersAuthorsJulia LichtnekertView作者出版物您也可以在中搜索这位作者。

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PubMed Google ScholarContributionsAll authors researched data for the article. All authors contributed substantially to discussion of the content. H.-J.A. wrote the first draft of the article. All authors reviewed and edited the manuscript before submission.Corresponding authorCorrespondence to.

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H.-J.A. has received consultancy and lecture fees from Otsuka, GSK, AstraZeneca, Bayer, Boehringer Ingelheim, Roche, Novartis and SOBI. J.L. declares no competing interests.

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Nature Reviews Rheumatology thanks Tak-Mao Chan, Mariele Gatto and the other, anonymous, reviewers for their contribution to the peer review of this work.

《自然评论风湿病》感谢陈德茂，玛丽·加托和其他匿名审稿人对这项工作的同行评审所做的贡献。

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Lupus nephritis-related chronic kidney disease..

狼疮性肾炎相关的慢性肾脏疾病。。

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