Rabbia C, Valpreda S
Department of Vascular and Interventional Radiology, San Giovanni Battista Hospital, Turin, Italy.
Int Angiol. 2003 Jun;22(2):101-15.
Renal artery stenosis is the most common cause of potentially remediable secondary hypertension. The most common causes include atherosclerosis and fibromuscular dysplasia. Particularly the atherosclerotic form is a progressive disease that may lead to gradual and silent loss of renal functional tissue. Thus, early diagnosis of renal artery stenosis is an important clinical objective since interventional therapy may improve or cure hypertension and preserve renal function. Screening for renal artery stenosis is indicated in the suspicion of renovascular hypertension or ischemic nephropathy in order to identify patients in which an endoluminal or a surgical revascularization is advisable. In the recent years many noninvasive tests have been proposed and evaluated in the clinical practice, in alternative to arteriography. These include nuclear scan, color Doppler sonography, CT angiography and MR angiography. Sonography is usually the first diagnostic modality for the non invasive evaluation of renal vascular disease with 95% sensitivity and 90% specificity when performed in dedicated laboratories. Despite sonography is highly affected by operator dependence, and it takes a lot of time to train good operators, actually is the best screening test because it is not expensive, non invasive and accurate. When a discrepancy exists between the clinical data and the results of US, other tests are mandatory.
肾动脉狭窄是潜在可治愈的继发性高血压最常见的病因。最常见的病因包括动脉粥样硬化和纤维肌发育不良。尤其是动脉粥样硬化型是一种进行性疾病，可能导致肾实质组织逐渐且隐匿性丧失。因此，肾动脉狭窄的早期诊断是一项重要的临床目标，因为介入治疗可改善或治愈高血压并保留肾功能。怀疑有肾血管性高血压或缺血性肾病时，需进行肾动脉狭窄筛查，以确定适合腔内或外科血管重建术的患者。近年来，临床实践中提出并评估了许多替代动脉造影的非侵入性检查方法。这些方法包括核扫描、彩色多普勒超声、CT血管造影和MR血管造影。超声检查通常是肾血管疾病非侵入性评估的首选诊断方法，在专业实验室进行时，其敏感性为95%，特异性为90%。尽管超声检查受操作者依赖性影响很大，且培养优秀的操作者需要很长时间，但实际上它是最佳的筛查检查，因为它价格低廉、非侵入性且准确。当临床数据与超声检查结果存在差异时，必须进行其他检查。
