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Том 10 №1 2008 год - Нефрология и диализ

Проблемы иммунодепрессивной терапии гломерулонефритов (Обзор литературы)


Николаев А.Ю. Ермоленко В.М. Захарова Е.В.

Аннотация: Bыживаемость больных первичным и вторичным хроническим гломерулонефритом (ХГН), а также быстропрогрессирующим гломерулонефритом (БПГН) за последние 20-30 лет увеличилась в 1,5-2 раза [2, 5, 16, 54, 71], однако возможности лечения гломерулонефритов и сегодня ограничены, а безопасность такого лечения недостаточна. Так, при лечении ударными дозами циклофосфана (ЦФ) и глюкокортикостероидов (ГКС) первичного фокального сегментарного гломерулосклероза (ФСГС), мембранозного нефрита (МН), пролиферативного волчаночного гломерулонефрита (ВГН) III и IV класса, в среднем у 50% больных не достигается полная ремиссия, и в последующие 5 лет у половины из них формируется хроническая почечная недостаточность - ХПН [17, 30, 38, 54]. Cреди причин смерти больных гломерулонефритом, длительно леченных неселективными цитостатиками и ГКС, важное место занимают вызванные лекарственным иммунодефицитом тяжелые оппортунистические инфекции, сепсис, онкологические заболевания [71], а также осложнения медикаментозного синдрома Кушинга [4].

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Ключевые слова: хронический гломерулонефрит, быстро-прогрессирующий гломерулонефрит, глюкокортикостероиды, циклофосфан, циклоспорин А, микофенолатa мофетил, антицитокиновые препараты, сиролимус, выживаемость, ремиссия

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