Renovascular hypertension and ischemic nephropathy.
Renovascular hypertension and ischemic nephropathy.
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DOI：
10.1038/ajh.2010.174
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发表时间：
2010-11
影响因子：
3.2
通讯作者：
Lerman, Lilach
中科院分区：
文献类型：
--
作者：
Textor, Stephen C.;Lerman, Lilach
关键词：
肾血管疾病仍然是继发性高血压和肾功能障碍最常见和最重要的原因之一。许多病变会降低灌注压，包括纤维肌肉疾病和肾梗死，但大多数是由动脉粥样硬化性疾病引起的。流行病学研究证实动脉粥样硬化性肾动脉狭窄与心血管风险之间有很强的相关性。肾血管疾病患者的高血压是由一系列复杂的升压信号引起的，包括肾素-血管紧张素系统的激活，氧化应激途径的重新启动，以及交感-肾上腺素能的激活。虽然肾脏在广泛的自我调节范围内保持功能，但肾脏灌注量的持续减少会导致微血管功能紊乱，血管稀疏，最终发展为间质纤维化。抗高血压药物治疗和强化危险因素治疗的进展，包括戒烟和他汀类药物治疗，可以为许多人提供良好的血压控制。尽管肾血管重建术在肾血管性高血压患者中有广泛的观察经验，但最近的前瞻性随机试验未能建立起令人信服的益处，无论是血管内支架还是手术，如果加上有效的药物治疗。这些试验是有限的，排除了许多最有可能从血运重建中受益的患者。一旦纤维化建立，血运重建后有意义的肾功能恢复是有限的。最近的实验研究表明，修复和再生实质肾组织的机制可能会在未来带来更好的结果。在其他分期工具出现之前，临床医生将被迫仔细地个体化治疗，以优化这类患者在血压和肾功能方面的潜在益处。
Renovascular disease remains among the most prevalent and important causes of secondary hypertension and renal dysfunction. Many lesions reduce perfusion pressure including fibromuscular diseases and renal infarction, but most are caused by atherosclerotic disease. Epidemiologic studies establish a strong association between with atherosclerotic renal artery stenosis and cardiovascular risk. Hypertension develops in patients with renovascular disease from a complex set of pressor signals, including activation of the renin-angiotensin system, recruitment of oxidative stress pathways, and sympatho-adrenergic activation. Although the kidney maintains function over a broad range of autoregulation, sustained reduction in renal perfusion leads to disturbed microvascular function, vascular rarefaction and ultimately development of interstitial fibrosis. Advances in antihypertensive drug therapy and intensive risk factor management including smoking cessation and statin therapy can provide excellent blood pressure control for many individuals. Despite extensive observational experience with renal revascularization in patients with renovascular hypertension, recent prospective randomized trials fail to establish compelling benefits either with endovascular stents or surgery when added to effective medical therapy. These trials are limited and exclude many patients most likely to benefit from revascularization. Meaningful recovery of kidney function after revascularization is limited once fibrosis is established. Recent experimental studies indicate that mechanisms allowing repair and regeneration of parenchymal kidney tissue may lead to improved outcomes in the future. Until additional staging tools become available, clinicians will be forced to individualize therapy carefully to optimize the potential benefits regarding both blood pressure and renal function for such patients.
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DOI：
10.1053/ejvs.2001.1559
发表时间：
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影响因子：
5.7
作者：
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作者：
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DOI：
10.1152/ajprenal.00385.2003
发表时间：
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影响因子：
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