结节性硬化症复合体与肾脏:肾病学家须知。

Aline Grosskopf Monich, John J Bissler, Fellype Carvalho Barreto
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引用次数: 0

摘要

结节性硬化症复合体(TSC)是一种常染色体显性遗传病,其特征是在中枢神经系统、心脏、皮肤、肺部和肾脏等部位出现火腿肠瘤,并伴有癫痫发作、皮质小管、放射状迁移纹、自闭症和认知障碍等其他表现。该病与 TSC1 或 TSC2 基因的致病变异有关,这些变异会导致 mTOR 通路过度激活,而 mTOR 通路是细胞生长和新陈代谢的关键调节因子。因此,mTOR 通路的过度激活会导致组织异常增殖和实体瘤的发生。TSC 肾脏受累的特点是发生囊性病变、肾细胞癌和肾血管脂肪瘤,这些病变可能会发展并引起疼痛、出血和肾功能丧失。mTOR 抑制剂已成为主要的治疗选择,而肾切除术和栓塞术等外科干预则主要用于对临床治疗无反应的并发症,如严重的肾出血。本综述重点介绍 TSC 的主要临床特征、肾脏受累的机制、肾脏病变治疗的最新进展以及未来展望。
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Tuberous Sclerosis Complex and the kidneys: what nephrologists need to know.

Tuberous sclerosis complex (TSC) is an autosomal dominant disease characterized by the development of hamartomas in the central nervous system, heart, skin, lungs, and kidneys and other manifestations including seizures, cortical tubers, radial migration lines, autism and cognitive disability. The disease is associated with pathogenic variants in the TSC1 or TSC2 genes, resulting in the hyperactivation of the mTOR pathway, a key regulator of cell growth and metabolism. Consequently, the hyperactivation of the mTOR pathway leads to abnormal tissue proliferation and the development of solid tumors. Kidney involvement in TSC is characterized by the development of cystic lesions, renal cell carcinoma and renal angiomyolipomas, which may progress and cause pain, bleeding, and loss of kidney function. Over the past years, there has been a notable shift in the therapeutic approach to TSC, particularly in addressing renal manifestations. mTOR inhibitors have emerged as the primary therapeutic option, whereas surgical interventions like nephrectomy and embolization being reserved primarily for complications unresponsive to clinical treatment, such as severe renal hemorrhage. This review focuses on the main clinical characteristics of TSC, the mechanisms underlying kidney involvement, the recent advances in therapy for kidney lesions, and the future perspectives.

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来源期刊
CiteScore
2.20
自引率
16.70%
发文量
208
审稿时长
16 weeks
期刊最新文献
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