Kane Garvan C, Textor Stephen C, Schirger Alexander, Garovic Vesna D
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Med. 2003 Jun 15;114(9):729-35. doi: 10.1016/s0002-9343(03)00161-x.
Despite the advances in antihypertensive therapy and renal revascularization, there remains a group of patients in whom renovascular disease leads to renal atrophy and treatment-resistant hypertension.
We performed an observational cohort study in which we reviewed blood pressures, renal function, and predictors of response in 74 patients who underwent nephrectomy of a small kidney for uncontrolled hypertension between 1990 and 2000.
The median age of the patients was 65 years; 43 (58%) were women. Thirty-five patients (47%) underwent nephrectomy as part of combined revascularization of the contralateral kidney. Associated atherosclerotic diseases were common (28% to 49%), as were prior renal revascularization (21 [28%]) and hypertensive urgency/emergencies (23 [31%]). The mean (+/- SD) long axis of the affected kidney was 8 +/- 2 cm, and the mean function of the kidney (based on radioisotope renography) was 12% +/- 11% of total renal function. The average systolic blood pressure fell from 168 +/- 19 mm Hg to 136 +/- 18 mm Hg (P <0.0001) and diastolic blood pressure declined from 88 +/- 10 mm Hg to 76 +/- 9 mm Hg (P <0.0001) at the most recent available clinic visit (mean follow-up, 4.1 +/- 2.6 years). In addition, the number of antihypertensive medications decreased from 3.2 +/- 1.1 to 2.2 +/- 1.5 (P <0.0001). Renal function remained stable. Results were similar (preoperative blood pressure of 165/88 mm Hg taking three medications to 137/77 mm Hg taking two medications) among the 39 patients who had a nephrectomy without contralateral revascularization.
Our results suggest that in selected patients with resistant hypertension and renal artery disease that has resulted in atrophic kidneys with reduced function, nephrectomy can improve blood pressure control without further loss in overall renal function.
尽管抗高血压治疗和肾血管重建取得了进展，但仍有一组患者，肾血管疾病导致肾萎缩和难治性高血压。
我们进行了一项观察性队列研究，回顾了1990年至2000年间因高血压控制不佳而接受小肾切除术的74例患者的血压、肾功能及反应预测因素。
患者的中位年龄为65岁；43例（58%）为女性。35例患者（47%）接受肾切除术作为对侧肾脏联合血管重建的一部分。相关的动脉粥样硬化疾病很常见（28%至49%），既往肾血管重建（21例[28%]）和高血压急症/紧急情况（23例[31%]）也很常见。患侧肾脏的平均（±标准差）长轴为8±2cm，肾脏的平均功能（基于放射性核素肾图）占总肾功能的12%±11%。在最近一次可获得的门诊随访时（平均随访4.1±2.6年），平均收缩压从168±19mmHg降至136±18mmHg（P<0.0001），舒张压从88±10mmHg降至76±9mmHg（P<0.0001）。此外，抗高血压药物的数量从3.2±1.1减少至2.2±1.5（P<0.0001）。肾功能保持稳定。在39例未进行对侧血管重建而接受肾切除术的患者中，结果相似（术前血压为165/88mmHg，服用三种药物，术后为137/77mmHg，服用两种药物）。
我们的结果表明，对于选定的患有难治性高血压和肾动脉疾病且已导致肾功能减退的萎缩性肾脏的患者，肾切除术可改善血压控制，而不会进一步导致总体肾功能丧失。
