葡萄糖皮质醇剂量和结果在ANCA相关的血管炎与脏参与
Maria Salman1, Mark Canney2,3, Ana Maria Naidas3
1Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Kidney international reports
|October 27, 2025
概括
针对严重的ANCA相关血管炎 (AAV) 和脏干扰的减少葡萄糖皮质激素 (GC) 治疗没有改变结果. 与标准GC使用相比,这种方法在末期病,死亡,感染或缓解率上没有显著差异.
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
- 免疫学 免疫学 免疫学
背景情况:
- 与脏相关的严重ANCA相关血管炎 (AAV) 通常需要免疫抑制疗法,包括葡萄糖皮质激素 (GCs).
- 指导方针建议减少GC剂量以最大限度地降低毒性,但对这种方法在严重的病AAV中的临床证据仍在争论中.
- 了解减少GC治疗对关键结果的影响对于优化患者管理至关重要.
研究的目的:
- 为了比较AAV治疗减少的GC治疗与标准GC诱导疗法治疗的活检证明的脏病患者的结果.
- 评估减少GC使用对功能恢复,疾病缓解和严重感染的影响.
主要方法:
- 一个单一中心的回顾性队列研究,对138名活检证明的AAV和脏参与的患者进行了研究 (2010-2023年).
- 根据实践转变,患者被分为两个时代:2020年以前 (标准-GC) 和2020年以后 (减少-GC).
- 主要结局:末期病 (ESKD) 或12个月内死亡的复合结局. 二次结局:严重的感染,缓解,以及估计的膜过率 (eGFR) 的变化.
主要成果:
- 降低GC组 (n=41) 年龄较大,与标准GC组 (n=97) 相比,基线功能较差.
- 在降低GC时代,累计GC减少为1个月后39%,3个月后28%,6个月后34%.
- 在ESKD或死亡 (24.4%对21.6%),严重感染 (14.6%对17.5%) 或缓解 (63.4%对63.9%) 之间没有观察到显著差异.
结论:
- 在有器官威胁性脏干扰的AAV中,降低GC诱导疗法与结果的不良变化或功能恢复无关.
- 这些发现支持减少GC疗程的安全性和有效性,与较大的随机试验数据保持一致.
- 这项研究提供了进一步的证据,为指导方针推的使用降低GC治疗在严重的AAV与损害.
相关概念视频
01:11Renal Failure: Dose Adjustments
429
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
429
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
425
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
425
01:25Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant
205
In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
205
01:26Nephrotic Syndrome II : Assessment and Medical Management
192
IntroductionNephrotic syndrome is a kidney disorder marked by excessive protein loss in the urine, leading to various systemic complications. This condition often results from damage to the glomeruli—the kidney's filtering units—causing proteinuria, low blood protein levels, and fluid retention. Understanding the assessment, diagnosis, and management of nephrotic syndrome is essential for effective treatment and prevention of further kidney damage.AssessmentPatient History: Document...
192
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
256
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
256
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
185
Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
185