Rambausek M, Fliser D, Ritz E
Department of Internal Medicine, University of Heidelberg, Germany.
Clin Nephrol. 1992;38 Suppl 1:S40-5.
Renal dysfunction as a consequence of malignant hypertension has been recognized for decades in patients with essential hypertension. It has been shown only recently, however, that albuminuria (including underlying albuminuria not detectable by conventional tests, i.e. microalbuminuria) has emerged as a frequent sequela of essential hypertension. Furthermore, renal dysfunction of the elderly as a result of ischemic nephropathy, in the absence of malignant hypertension, has turned out to be an important long-term outcome in the patient with essential hypertension. The presence of albuminuria is a strong predictor of cardiovascular events. Albuminuria is associated with more severe hypertension and with evidence of more advanced target organ damage (e.g. LVH). It is more prevalent in the elderly. It is unknown whether the predictive value of albuminuria reflects its association with more severe hypertension and end-organ damage, or whether albuminuria serves as an indicator of capillary leakiness which causes detectable abnormalities in the renal microcirculation but reflects more generalized endothelial barrier dysfunction predisposing to accelerated atherogenesis.
数十年来，恶性高血压导致的肾功能不全在原发性高血压患者中已得到公认。然而，直到最近才发现，蛋白尿（包括常规检测无法检测到的潜在蛋白尿，即微量白蛋白尿）已成为原发性高血压常见的后遗症。此外，在没有恶性高血压的情况下，缺血性肾病导致的老年人肾功能不全已成为原发性高血压患者重要的长期结局。蛋白尿的存在是心血管事件的有力预测指标。蛋白尿与更严重的高血压以及更晚期靶器官损害（如左心室肥厚）的证据相关。它在老年人中更为普遍。尚不清楚蛋白尿的预测价值是反映其与更严重的高血压和终末器官损害的关联，还是蛋白尿作为毛细血管渗漏指标，导致肾微循环中可检测到异常，但反映了更广泛的内皮屏障功能障碍，易引发动脉粥样硬化加速。
