Kidney dysfunction in patients with pulmonary arterial hypertension.
Kidney dysfunction in patients with pulmonary arterial hypertension.
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DOI：
10.1086/690018
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发表时间：
2017-03
影响因子：
2.6
通讯作者：
Austin ED
中科院分区：
文献类型：
--
作者：
Nickel NP;O'Leary JM;Brittain EL;Fessel JP;Zamanian RT;West JD;Austin ED
肺动脉高压(PH)和慢性肾脏疾病(CKD)都深刻地影响着患者的预后，无论是作为原发病状态还是作为共病状态。Ph是CKD中常见的并存疾病，反之亦然。越来越多的文献描述了继发于慢性肾脏疾病和终末期肾病(ESRD)的PH的流行病学(世卫组织第5组PH)。但是，关于第一组PH(肺动脉高压[PAH])肾脏疾病的流行病学数据有限。这篇综述的目的是总结目前的流行病学数据，并讨论PAH中潜在的疾病机制和肾功能障碍的治疗意义。肾功能障碍，由血肌酐或估计的肾小球滤过率确定，是PAH的常见并存疾病，肾功能受损是死亡率的强大和独立预测因素。PAH影响肾脏的潜在机制是静脉充血增加、心输出量减少和神经激素激活。在分子水平上，转化生长因子-β信号的增加和循环细胞因子水平的增加可能会导致肾功能恶化。肾毒性似乎不是PAH靶向治疗的常见副作用。PAH肾病的治疗意义包括血糖控制、生活方式改变以及潜在的肾素-血管紧张素-醛固酮系统(RAAS)阻断。
Pulmonary arterial hypertension (PH) and chronic kidney disease (CKD) both profoundly impact patient outcomes, whether as primary disease states or as co-morbid conditions. PH is a common co-morbidity in CKD and vice versa. A growing body of literature describes the epidemiology of PH secondary to chronic kidney disease and end-stage renal disease (ESRD) (WHO group 5 PH). But, there are only limited data on the epidemiology of kidney disease in group 1 PH (pulmonary arterial hypertension [PAH]). The purpose of this review is to summarize the current data on epidemiology and discuss potential disease mechanisms and management implications of kidney dysfunction in PAH. Kidney dysfunction, determined by serum creatinine or estimated glomerular filtration rate, is a frequent co-morbidity in PAH and impaired kidney function is a strong and independent predictor of mortality. Potential mechanisms of PAH affecting the kidneys are increased venous congestion, decreased cardiac output, and neurohormonal activation. On a molecular level, increased TGF-β signaling and increased levels of circulating cytokines could have the potential to worsen kidney function. Nephrotoxicity does not seem to be a common side effect of PAH-targeted therapy. Treatment implications for kidney disease in PAH include glycemic control, lifestyle modification, and potentially Renin-Angiotensin-Aldosterone System (RAAS) blockade.
DOI：
10.1016/j.curtheres.2013.06.002
发表时间：
2013-12
影响因子：
1.9
作者：
Ay, Yasin;Kara, Ibrahim;Ay, Nuray Kahraman;Aydin, Cemalettin;Koksal, Cengiz;Gorur, Durmus Alper;Findik, Orhan
通讯作者：
Findik, Orhan