慢性糸球体腎炎の病態・診断・治療(最終講義)

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  • サイシュウ コウギ マンセイ シキュウタイジンエン ノ ビョウタイ シンダン チリョウ ガン ニヘイヒロシ センセイゴリャクレキ
  • Chronic Glomerulonephritis : Pathophysiology, Treatments, and Prognoses(Lecture)

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Chronic dialysis patients in Japan numbered approximately 240,000 in 2004. The enormous medical cost to treat these patients has become a socio-economic problem. Diabetic nephropathy, nephrosclerosis and chronic glomerulonephritis are the main causative diseases for dialysis. Among these diseases, only chronic glomerulonephritis does not yet have a decisive strategy to prevent its progression. IgA nephropathy constitutes half of all chronic glomerulonephritis. A government research group established a standard to predict the prognoses of these patients based on biopsy specimens. The standard listed clinical signs of hypertension (>140/85), massive proteinuria (>1 g/day), and low renal function (Ccr <70 ml/min) to be ominous prognoses. Blood pressure control is very important to prevent the progression of renal deterioration. Thus, the use of various methods such as antihypertensive drugs to control blood pressure under 125/75 mmHg among renal disease patients with proteinuria of more than 1 g/day is recommended. In addition, angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor antagonist (ARB) are believed to exert additional effects to conserve renal function. Steroid is an effective drug to treat IgA nephropathy subjects with Ccr >70 ml/min, proteinuria >0.5 g/day, and also with histological activity in biopsy specimen. Although many efforts have gained favorable results, administrative maneuvers are still necessary to achieve effective outcomes.

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