PDF(Pubmed)
Abstract：
Chronic kidney disease (CKD) is a modern epidemic worldwide. Introducing renin-angiotensin system (RAS) inhibitors (i.e., ACEi or ARB) not only as blood-pressure-lowering agents, but also as nephroprotective drugs with antiproteinuric potential was a milestone in the therapy of CKD. For decades, this treatment remained the only proven strategy to slow down CKD progression. This situation changed some years ago primarily due to the introduction of drugs designed to treat diabetes that turned into nephroprotective strategies not only in diabetic kidney disease, but also in CKD unrelated to diabetes. In addition, several drugs emerged that precisely target the pathogenetic mechanisms of particular kidney diseases. Finally, the role of metabolic acidosis in CKD progression (and not only the sequelae of CKD) came to light. In this review, we aim to comprehensively discuss all relevant therapies that slow down the progression of non-diabetic kidney disease, including the lowering of blood pressure, through the nephroprotective effects of ACEi/ARB and spironolactone independent from BP lowering, as well as the role of sodium-glucose co-transporter type 2 inhibitors, acidosis correction and disease-specific treatment strategies. We also briefly address the therapies that attempt to slow down the progression of CKD, which did not confirm this effect. We are convinced that our in-depth review with practical statements on multiple aspects of treatment offered to non-diabetic CKD fills the existing gap in the available literature. We believe that it may help clinicians who take care of CKD patients in their practice. Finally, we propose the strategy that should be implemented in most non-diabetic CKD patients to prevent disease progression.
摘要：
慢性肾脏病(CKD)是世界范围内的现代流行病。引入肾素-血管紧张素系统(RAS)抑制剂(即，ACEi或ARB）不仅作为降压剂，而且作为具有抗蛋白尿潜能的肾保护药物也是CKD治疗的一个里程碑.几十年来,这种治疗仍然是唯一被证实的减缓CKD进展的策略.几年前，这种情况发生了变化，主要是由于引入了旨在治疗糖尿病的药物，这些药物不仅在糖尿病肾病中成为肾脏保护策略，但也与糖尿病无关的CKD。此外,出现了几种精确靶向特定肾脏疾病发病机制的药物。最后,代谢性酸中毒在CKD进展中的作用（不仅是CKD的后遗症）逐渐显现出来。在这次审查中,我们旨在全面讨论减缓非糖尿病肾病进展的所有相关疗法，包括降低血压，通过ACEi/ARB和螺内酯的肾保护作用，以及钠-葡萄糖协同转运蛋白2型抑制剂的作用，酸中毒矫正和疾病特异性治疗策略。我们还简要讨论了试图减缓CKD进展的疗法，这并没有证实这种影响。我们坚信，我们对非糖尿病性CKD治疗的多个方面的实际陈述进行了深入审查，填补了现有文献中的空白。我们相信，它可以帮助临床医生在他们的实践中照顾CKD患者。最后,我们提出了应在大多数非糖尿病CKD患者中实施的预防疾病进展的策略.
