慢性病:2019年EULAR/ERA-EDTA针对狼性炎的建议中缺失的概念
Jorge E Rojas-Rivera1,2, Sevcan A Bakkaloglu3,4, Davide Bolignano3,5
1IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT, Madrid, Spain.
概括
狼性炎 (LN) 是慢性病 (CKD) 的原因之一. 目前的指导方针忽略了CKD和白蛋白尿在LN管理中,尽管心血管风险很高. 将LN整合到CKD框架中对于患者护理至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 类风湿病学 类风湿病学
- 心脏病学 心脏病学
背景情况:
- 慢性病 (CKD) 被定义为膜过率 (GFR) 降低或尿白蛋白:肌素比率 (UACR) 升高,表明不良结果的风险增加,包括心血管死亡率.
- 狼性炎 (LN) 是慢性病的重要原因,但欧拉/ERA-EDTA和欧拉的当前管理指南并未充分解决LN患者的白蛋白尿或慢性病.
- 这种监督至关重要,因为患有严重CKD和高心血管风险的患者,通常在LN中见到,可以从已建立的心血管疾病预防策略中受益.
研究的目的:
- 倡导管理狼性炎 (LN) 的范式转变.
- 将LN整合到慢性病 (CKD) 的更广泛理解中.
- 确保从大型CKD试验获得的证据应用于LN管理.
主要方法:
- 审查目前的欧洲反风湿联盟 (EULAR) 和欧洲脏协会-欧洲透析和移植协会 (ERA-EDTA) 关于LN和心血管风险管理的建议.
- 对CKD的诊断标准的分析,包括GFR和UACR值.
- 与现有的心血管疾病预防指南进行比较.
主要成果:
- 目前的LN管理指南缺乏专注于白蛋白尿和CKD.
- 在LN建议中蛋白尿的目标可能与严重CKD和高心血管风险的患者的需求不一致.
- 现有的心血管疾病预防指南在LN管理中可能未得到充分利用.
结论:
- 应该将LN概念化为CKD的原因,而不是一个单独的实体.
- 对于LN管理的建议应纳入CKD原则和来自大型CKD试验的证据.
- 采用综合方法将改善LN患者的心血管风险管理.
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