Schaeffer A J, Stamery T A
Urol Clin North Am. 1975 Jun;2(2):327-35.
It is apparent that the split function study and renal vein renin determination are complementary and afford valuable information for selecting patients with potentially curable renovascular hypertension. The split function study, when interpreted with the recently defined split function ratio, offers the clinician a highly accurate means of diagnosing significant renal ischemia. Because the split function ratio shows the disparity between the ischemic and contralateral kidney to a greater degree, the chance of misdiagnosis due to laboratory or physician error is minimized. The split function study, however, is of limited value in patients with pyelonephritis since the water- and salt-losing characteristics of the pyelonephritic kidney may mask significant renal ischemia. In these patients, as well as those with a nonfunctioning kidney or hydronephrosis, the renal vein renin determination is the test of choice. In addition, the added morbidity of the split function study is not warranted in a patient with an elevated peripheral renin which, for interpretation, requires an accurate 24 hour urine for sodium, a renal vein renin ratio outside the range of patients with essential hypertension (renal vein renin ratio greater than 1.7) and evidence of suppression of renin secretion from the contralateral kidney. If, however, the renin determination does not afford convincing evidence of significant renal ischemia in a patient with radiographic evidence of renal arterial stenosis, a split function ratio definitely should be determined to more completely define the pathology. The attendant morbidity of a carefully performed split renal function study does not approach the morbidity and mortality associated with unnecessary surgery or inadequately treated hypertension.
显然，分肾功能研究和肾静脉肾素测定是互补的，为选择可能治愈的肾血管性高血压患者提供了有价值的信息。当结合最近定义的分肾功能比进行解释时，分肾功能研究为临床医生提供了一种高度准确的诊断明显肾缺血的方法。由于分肾功能比能更清楚地显示缺血肾与对侧肾之间的差异，因实验室或医生失误导致误诊的可能性降至最低。然而，分肾功能研究在肾盂肾炎患者中的价值有限，因为肾盂肾炎肾的失盐失水特性可能掩盖明显的肾缺血。在这些患者以及无功能肾或肾积水患者中，肾静脉肾素测定是首选检查。此外，对于外周肾素升高的患者，进行分肾功能研究增加的发病率是不必要的，因为要进行解释，需要准确的24小时尿钠测定、肾静脉肾素比超出原发性高血压患者范围（肾静脉肾素比大于1.7）以及对侧肾肾素分泌受抑制的证据。然而，如果肾素测定在有肾动脉狭窄影像学证据的患者中不能提供明显肾缺血的确凿证据，则肯定应测定分肾功能比以更全面地明确病理情况。精心进行的分肾功能研究带来的发病率远不及不必要手术或高血压治疗不充分相关的发病率和死亡率。
