成人难治性肾病综合征治疗的免疫抑制剂选择

难治性肾病综合征在肾脏内科常见,但在确定其为"真性"难治性之前,必须排除"假性"可能,常见的"假性"难治原因包括：诊断错误;治疗不规范导致肾病综合征频繁复发;激素的用法不当;患者的依从性差及存在并发症等。对于"真性"难治性肾病综合征,可以根据不同肾脏病变的病理类型采取相应的治疗措施。2012年KDIGO对慢性肾小球肾炎治疗的指南提出了建立在最新循征医学基础上的治疗方案,其中涉及难治性肾病综合征免疫抑制药物方案的选择,对全球的肾脏科医师有重要的指导意义。

Selection of immunosuppressants for treatment of adult refractory nephrotic syndrome

Refractory nephrotic syndrome is very common in the nephrology department, but before its diagnosis is confirmed, the false refractory nephrotic syndrome must be excluded. The diagnosis of false refractory disease may result from incorrect diagnosis, substandard treatment leading to its frequent relapses, improper usage of steroids, poor compliance of patients, and complications existed. For nephrotic syndrome, proper treatments should be used according to the renal pathology. The 2012 KDIGO guidelines for treatment of chronic glomerulonephritis proposed treatment regimens on the basis of latest evidence-based medicine, which involved selection of drug regimens of immunosuppressants for intractable nephrotic syndrome, being of important guiding significance for renal physicians around the world.