Macgregor A M, Cade J R
Surg Gynecol Obstet. 1975 Jan;140(1):97-110.
Continuing interest in the mechanism of hypertension have produced considerable new information on the underlying pathophysiologic processes involved. Elucidation of the role of renal malperfusion, the renin-angiotensin-aldosterone mechanism, and renal medullary antihypertensive substances continues to clarify our understanding of renal hypertension. Current evidence suggests that angiotensin can produce hypertension by a direct effect on peripheral blood vessels in malignant hypertension and in renin-secreting renal tumors and by an intrarenal mechanism influencing intrarenal distribution of blood flow, and, thereby, sodium resorption in chronic renovascular hypertension. The current diagnostic techniques used to determine the presence of renal atery stenosis and its functional significance are reviewed. Arteriographic evidence of renal artery collaterals and a positive differential venous renin ratio are the two parameters whose usefulness and practicality have been best documented in recent years. The results of surgical procedures reported in the world literature show a 50 per cent rate with a further 30 per cent improvement rate in terms of control of hypertension. When functional significance of stenosis is demonstrated before surgical procedures, cure rates of the order of 80 per cent can be achieved. Recent developments of technique of operating room upon less extensive lesions of the renal artery branch extend the possibilities of surgical benefit which should also be considered in the presence of renal failure of renovascular origin.
对高血压发病机制的持续关注产生了大量有关潜在病理生理过程的新信息。对肾灌注不良、肾素 - 血管紧张素 - 醛固酮机制以及肾髓质抗高血压物质作用的阐明，不断深化我们对肾性高血压的理解。目前的证据表明，血管紧张素可通过对恶性高血压和肾素分泌性肾肿瘤外周血管的直接作用，以及通过影响肾内血流分布从而影响慢性肾血管性高血压中钠重吸收的肾内机制来导致高血压。本文综述了目前用于确定肾动脉狭窄的存在及其功能意义的诊断技术。肾动脉侧支循环的血管造影证据和阳性的静脉肾素差异比值是近年来其有用性和实用性得到最佳证明的两个参数。世界文献报道的外科手术结果显示，高血压控制率为50%，另有30%的改善率。若在手术前证实狭窄具有功能意义，则治愈率可达80%左右。手术室针对肾动脉分支较小范围病变的技术新进展扩大了手术获益的可能性，在肾血管性起源的肾衰竭情况下也应考虑这些进展。
