Renal effects of angiotensin converting enzyme inhibitors: nondiabetic chronic renal disease.
Renal effects of angiotensin converting enzyme inhibitors: nondiabetic chronic renal disease.
复制标题
血管紧张素转换酶抑制剂的肾脏影响：非糖尿病慢性肾病。
DOI：
10.1007/bf01857636
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发表时间：
1990
影响因子：
3.4
通讯作者：
Keane,WF
中科院分区：
文献类型：
--
作者：
Opsahl,JA;Abraham,PA;Keane,WF
基于大鼠残肾模型的研究，有人提出肾小球高血压是慢性肾病进展的原因。在该模型中，血管紧张素转换酶（ACE）抑制剂治疗降低了肾小球压力。结果，肾小球损伤减少，肾病进展速度减慢。因此，血流动力学的改变可能在肾小球损伤中发挥重要作用。然而，现在很明显，多种代谢因素和其他因素会影响肾脏疾病的进展。此外，最近的研究表明，ACE 抑制剂还可能具有与肾小球压力变化无关的有益作用。在人类中，肾小球血流动力学对肾脏疾病的反应无法测量，并且尚不清楚肾小球毛细血管压力是否或在何种条件下可能升高。对于非糖尿病慢性肾功能衰竭患者，ACE 抑制剂治疗可安全降低血压，且不会对肾功能产生不利影响。尽管某些患者的蛋白尿和肾病进展率可能会降低，但这些影响的观察结果并不一致。识别调节 ACE 抑制反应变异性的因素可能为人类进行性肾病的发病机制和治疗提供新的见解。
Based on studies in the rat remnant kidney model, it has been proposed that glomerular hypertension is responsible for the progressive nature of chronic renal disease. In that model, therapy with angiotensin converting enzyme (ACE) inhibitors reduced glomerular pressures. As a result, glomerular injury was reduced and the rate of progression of renal disease was slowed. Thus, alterations in hemodynamics may play an important role in glomerular injury. However, it is now evident that a variety of metabolic and other factors affect the progression of renal disease. Moreover, recent studies suggest that ACE inhibitors may also have beneficial effects that are independent of alterations in glomerular pressure. In humans, the glomerular hemodynamic response to renal disease cannot be measured, and it is not known whether or under which conditions glomerular capillary pressure might be elevated. Treatment with ACE inhibitors safely lowers blood pressure without adversely affecting renal function in mots patients with nondiabetic chronic renal failure. Although proteinuria and the rate of progression of renal disease may decrease in some patients, these effects are inconsistently seen. Identification of the factors that modulate this variability in response to ACE inhibition may provide new insight into the pathogenesis and treatment of progressive renal disease in humans.