慢性腎臓病関連の最新の研究と治療

Update on Research and Treatment of Chronic Kidney Disease

Point

・多くの慢性腎臓病特異的因子と非特異的因子が相互に作用し，慢性腎臓病患者における大脳の構造的および機能的変化に寄与している．

・逆に神経から腎への影響として，迷走神経刺激が急性腎障害の軽減につながることがわかってきている．

・近年登場した新規薬剤としては，慢性腎臓病に対してSGLT2（sodium/glucose cotransporter 2）阻害薬が，2型糖尿病を合併する慢性腎臓病に対してミネラルコルチコイド受容体拮抗薬であるフィネレノンが，腎性貧血に対して低酸素誘導因子-プロリン水酸化酵素阻害薬がそれぞれ適応となった．

　The kidney and brain share strain vessels, which are short and small arterioles that branch out of larger arteries. These vessels are vulnerable to risk factors such as atherosclerosis, old age, hypertension, diabetes, dyslipidemia, and smoking. The nervous system and the kidneys interact to maintain homeostasis. Many chronic kidney disease（CKD）-specific and nonspecific factors contribute to structural and functional cerebral changes in patients with CKD. In contrast, vagus nerve stimulation has been reported to alleviate inflammatory diseases, including kidney disease. Several new drugs have recently become available for the treatment of CKD: sodium-glucose co-transporter-2 inhibitors for CKD; finerenone, a mineralocorticoid receptor antagonist for CKD with type 2 diabetes; and a hypoxia-inducible factor prolyl-hydroxylase inhibitor for anemia in patients with CKD.