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Том 17 №2 2015 год - Нефрология и диализ

Применение циклоспорина а для лечения нефротических типов хронических гломерулонефритов - болезни минимальных изменений и фокального сегментарного гломерулосклероза


Руденко Е.В. Томилина Н.А. Захарова Е.В.

Аннотация: В настоящее время применение Циклоспорина А (ЦcА) является признанным методом лечения нефротических вариантов гломерулонефритов (ГН), в основе которых лежит повреждение подоцитов. Этот препарат занял общепризнанное место в лечении БМИ и ФСГС, при которых он используется чаще всего в комбинации с кортикостероидами (ГКС) и рекомендуется, главным образом, при ГКС-рефрактерности либо при непереносимости или наличии противопоказаний к ГКС. Кроме того, применение ЦсА предлагается для поддержания ремиссии нефротического синдрома (НС), достигнутой ГКС-терапией, а также для профилактики и/или лечения рецидивов заболевания. В обзоре представлены общие сведения и механизмы действия ЦсА на Т-лимфоциты (иммуносупрессивный эффект), на неиммунные клетки и непосредственно на подоцит (антипротеинурический эффект). Считается, что эффективность ЦсА при лечении НС у пациентов с ФСГС связана с ингибицией кальцинейрин-обусловленного дефосфорилирования и уменьшением распада белка синаптоподина, результатом чего является стабилизация подоцитарного актинового цитоскелета, повреждаемого, в частности, факторами проницаемости, особенно при наличии определенной генетической предрасположенности. В данной статье приводится обзор литературы по применению ЦсА в лечении нефротических видов гломерулонефритов - болезни минимальных изменений и фокальном сегментарном гломерулосклерозе.

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Ключевые слова: болезнь минимальных изменений, фокально-сегментарный гломерулосклероз, нефротический синдром, циклоспорин А, подоцитопатия, синаптоподин, minimal change disease, focal segmental glomerulosclerosis, nephrotic syndrome, cyclosporine A, podocytopathy, sinaptopodin

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