diuretic braking啥意思？

Control of proteinuria is key to mitigating risk of progression. Almost all trials of non-diabetic chronic kidney disease demonstrate that reducing proteinuria improves renal survival. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers should be used at maximally tolerated doses, except in MCD, where proteinuria reduction is often seen rapidly with treatment. Dual angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker therapy is generally not recommended due to increased risks of hyperkalemia and elevating the serum creatinine. Non-dihydropyridine calcium channel blockers (verapamil and diltiazem) can be used to in lieu of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers when the latter are contraindicated. 

• For proteinuria >1 gram per day, target blood pressure is <125/75 mm Hg. 

• With the exception of MCD, patients with nephrotic-range proteinuria and hyperlipidemia should be treated with HMG CoA synthetase inhibitors (statins).

• Although some patients with nephrotic syndrome are hypercoagulable (particularly patients with membranous nephropathy), the role of prophylactic anticoagulation is not well-defined and controversial. For patients with membranous nephropathy and serum albumin levels <2.0 g/dl, anticoagulation should be considered if bleeding risk is low. 

• Low sodium diet (<2 gram per day) with diuretics. 

• Diuretic resistance is common due to gut wall edema and hypoalbuminemia. More bioavailable diuretics (bumetanide, torsemide) may increase urine output better than furosemide, along with thiazide diuretics. 

• To prevent “diuretic braking,” most loop diuretics should be dosed at least on a twicedaily basis.

l 控制蛋白尿是降低疾病进展风险的关键。几乎所有非糖尿病慢性肾病的试验都表明，减少蛋白尿可以提高肾脏存活率。除MCD外，血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂应在最大耐受剂量下使用，在MCD中，治疗后蛋白尿通常会迅速减少。由于高钾血症和血清肌酐升高的风险增加，通常不建议联合使用血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂。非二氢吡啶类钙通道阻滞剂(维拉帕米和地尔硫卓)可用于替代血管紧张素转换酶抑制剂、血管紧张素II受体阻滞剂(当后者禁忌时)。

l 对于每天1克以上的蛋白尿，其目标血压为<125/75mmhg。

l 除了微小病变型，肾病范围的蛋白尿和高脂血症患者推荐使用HMG辅酶A合成酶抑制剂(他汀类)。

l 虽然一些肾病综合征患者处于高凝状态(尤其是膜性肾病患者)，但预防性抗凝的作用尚未明确且存在争议。对于膜性肾病和血清白蛋白水平< 2.0 g/dl的患者，如果出血风险较低，应考虑抗凝治疗。

l 低钠饮食(每天<2克)加利尿剂。

l 由于肠壁水肿和低白蛋白血症，利尿剂抵抗很常见。生物利用度更高的利尿剂(布美他尼、托司米)可能比呋塞米和噻嗪类利尿剂更好地增加尿量。

diuretic braking啥意思？谢谢