Chronic kidney disease: A new look at pathogenetic mechanisms and treatment options

被引：24
作者：
Noone D. [1 ,2 ]
Licht C. [1 ,2 ,3 ]
机构：
[1] Division of Nephrology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON M5G 1X8
[2] Program in Cell Biology, Hospital for Sick Children, Toronto, ON
[3] Department of Paediatrics, University of Toronto, Toronto, ON
来源：
Pediatric Nephrology | 2014年 / 29卷 / 5期
关键词：
Chronic kidney disease; Proteinuria; Treatment;
D O I：
10.1007/s00467-013-2436-5
中图分类号：
学科分类号：
摘要：
The concept of renoprotection has evolved significantly, driven by improved understanding of the pathophysiology of chronic kidney disease (CKD) and the advent of novel treatment options. Glomerular hyperfiltration, hypertension and proteinuria represent key mediators of CKD progression. It is increasingly recognized that proteinuria may actually be pathological and etiological in CKD progression and not just symptomatic. It initiates a sequence of events involving activation of proinflammatory and profibrotic signaling pathways in proximal tubular epithelial cells with transmission of the disease to the tubulointerstitium and progression to end-stage kidney disease (ESKD). Although the etiology and epidemiology of pediatric CKD differs to that in adults, studies in the various animal models of kidney disease, from obstructive uropathy to glomerulonephritis, have revealed that many common proinflammatory and profibrotic pathways are induced in progressive proteinuric CKD, irrespective of the primary disease. This pathomechanistic overlap therefore translates into the potential for common treatment targets for a wide spectrum of kidney diseases. In this review we therefore discuss the experimental and clinical evidence for an array of prospective future drug treatments of CKD progression. While conceptually promising, clear definitive evidence beyond preclinical data does not exist for many of these treatments, and others are limited by serious adverse effects. More studies are needed before general recommendations can be given. © 2013 IPNA.
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页码：779 / 792
页数：13
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