Eardley K S, Lipkin G W
Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
J Hum Hypertens. 1999 Apr;13(4):217-20. doi: 10.1038/sj.jhh.1000785.
Atherosclerotic renal artery stenosis (ARAS) is the commonest cause of secondary hypertension and is the cause of end stage renal failure in up to 20% of patients starting dialysis. Associated with it is a high morbidity and appalling mortality. The aetiology of ischaemic nephropathy is complex and is not simply related to renal artery narrowing. Captopril renography is sensitive and specific for diagnosing ARAS in patients with normal renal function. In those with renal impairment gadolinium-enhanced MRA or spiral CT angiography clearly define renal anatomy. Over 80% of ARAS is ostial. Studies of revascularisation with angioplasty show poor short and long term patency rates. Renal artery stenting leads to high initial technical success and long term patency. Recent randomised controlled trials in patients with renovascular hypertension demonstrate no clear benefit of adequate revascularisation over medical therapy. Renal artery stenting for renal protection in ARAS appears more encouraging and current randomised controlled trials are in progress to answer the question definitively.
动脉粥样硬化性肾动脉狭窄（ARAS）是继发性高血压最常见的病因，在开始透析的患者中，高达20%的患者终末期肾衰竭由其引起。与之相关的是高发病率和惊人的死亡率。缺血性肾病的病因复杂，并非简单地与肾动脉狭窄有关。卡托普利肾图对肾功能正常的患者诊断ARAS敏感且特异。对于肾功能受损的患者，钆增强磁共振血管造影（MRA）或螺旋CT血管造影能清晰显示肾脏解剖结构。超过80%的ARAS发生在肾动脉开口处。血管成形术血运重建研究显示短期和长期通畅率均较差。肾动脉支架置入术初始技术成功率高且长期通畅。近期针对肾血管性高血压患者的随机对照试验表明，充分血运重建相较于药物治疗并无明显益处。肾动脉支架置入术对ARAS患者进行肾脏保护似乎更具前景，目前正在进行随机对照试验以明确回答该问题。
