Hayashi K, Ozawa Y, Tokuyama H
Department of Internal Medicine, School of Medicine, Keio University.
Nihon Rinsho. 2001 May;59(5):955-60.
Renal disease constitutes an important determinant of cardiovascular disease. Although the mechanisms for the progression of renal impairment remain fully undetermined, available evidence indicate that renal glomerular hypertension is responsible in part for the development of renal injury. In renal disease, afferent arteriolar tone is reported to be reduced, while the augmented intrarenal angiotensin II serves to act as an efferent arteriolar constrictor, both of which result in an increase in glomerular capillary pressure. Angiotensin converting enzyme inhibitors (ACE-I) are established as the agent possessing both antihypertensive and renoprotective actions, which exert vasodilator action on efferent arterioles. Calcium antagonists are also reported to have salutary effect on renal disease, although their beneficial action varies depending on the antagonists used and the underlying disease. The use of calcium antagonists, however, is mandatory particularly under the circumstance where renal failure moderately to severely progresses and the ACE-I cannot be used.
肾脏疾病是心血管疾病的一个重要决定因素。尽管肾功能损害进展的机制仍完全不明，但现有证据表明，肾小球高血压部分导致了肾损伤的发生。在肾脏疾病中，据报道入球小动脉张力降低，而肾内血管紧张素II增加起到出球小动脉收缩剂的作用，这两者均导致肾小球毛细血管压力升高。血管紧张素转换酶抑制剂（ACE-I）被确认为具有降压和肾脏保护作用的药物，其对出球小动脉发挥血管舒张作用。也有报道称钙拮抗剂对肾脏疾病有有益作用，尽管其有益作用因所使用的拮抗剂和基础疾病而异。然而，特别是在肾衰竭中度至重度进展且无法使用ACE-I的情况下，必须使用钙拮抗剂。
