Tom 3, Nr 3 (2023)
Poglądy, stanowiska, zalecenia, standardy
Opublikowany online: 2023-10-20
Wyświetlenia strony 1028
Wyświetlenia/pobrania artykułu 185
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Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Farmakologiczne leczenie nefroprotekcyjne w niecukrzycowej przewlekłej chorobie nerek — stanowisko Polskiego Towarzystwa Nefrologicznego dotyczące praktyki klinicznej

Tomasz Stompór1, Marcin Adamczak2, Ilona Kurnatowska3, Beata Naumnik4, Michał Nowicki5, Leszek Tylicki6, Agata Winiarska1, Magdalena Krajewska7
Forum Nefrologiczne - Edukacja 2023;3(3):65-103.

Streszczenie

Na całym świecie przewlekła choroba nerek (CKD, chronic kidney disease) ma charakter epidemii. Kamieniem milowym w leczeniu CKD było wprowadzenie inhibitorów układu renina–angiotensyna (RAS, renin–angiotensin system) (tj. ACEi lub ARB) nie tylko w charakterze leków obniżających ciśnienie tętnicze, lecz także działających nefroprotekcyjnie i posiadających potencjał redukcji białkomoczu. Przez dziesięciolecia leczenie to pozostawało jedyną udowodnioną strategią spowalniającą progresję przewlekłej choroby nerek. Sytuacja ta uległa zmianie kilka lat temu, przede wszystkim dzięki wprowadzeniu leków przeznaczonych do leczenia cukrzycy, które wykazały swoje działanie nefroprotekcyjne nie tylko w cukrzycowej chorobie nerek, ale także w CKD niezwiązanej z cukrzycą. Ponadto pojawiło się kilka leków precyzyjnie ukierunkowanych na mechanizmy patogenetyczne niektórych chorób nerek. Wykazano ponadto rolę kwasicy metabolicznej w progresji przewlekłej choroby nerek (a nie tylko jako następstwa CKD). W niniejszym artykule przeglądowym staramy się kompleksowo omówić wszystkie mające znaczenie terapie przyczyniające się do spowolnienia progresji niecukrzycowej choroby nerek, w tym leki obniżające ciśnienie tętnicze, poprzez nefroprotekcyjne działanie ACEi/ARB i spironolaktonu niezależne od obniżenia ciśnienia krwi, a także rolę inhibitorów kotransportera sodowo-glukozowego typu 2, leczenia kwasicy i strategie leczenia ukierunkowane na patomechanizm niektórych chorób. Pokrótce omawiamy także terapie mające spowalniać progresję CKD, dla których nie potwierdzono takiego działania. Jesteśmy przekonani, że opracowany przez nas szczegółowy przegląd zawierający praktyczne stanowisko dotyczące wielu aspektów leczenia pacjentów z niecukrzycową przewlekłą chorobą nerek, wypełni istniejącą lukę w dostępnej literaturze. Wierzymy, że może on stanowić pomoc dla lekarzy opiekujących się pacjentami z CKD w swojej praktyce klinicznej. Proponujemy również strategię postępowania, którą należy wdrożyć u większości pacjentów z niecukrzycową przewlekłą chorobą nerek, aby przeciwdziałać progresji choroby.

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