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[慢性肾小球肾炎患者动脉高血压的形态功能平行关系]

[The morphofunctional parallels in arterial hypertension in patients with chronic glomerulonephritis].

作者信息

Riabov S I, Gadaev A, Kotovoĭ Iu O, Kucher A G, Degtereva O A, Kaiukov I G

出版信息

Ter Arkh. 1992;64(6):26-9.

PMID:1440331
Abstract

The restructure of renal tissue in intravital nephric biopsy specimens, renin-angiotensin-aldosterone together with kallikrein synthetic functions were studied and compared in patients with mesangioproliferative and membranoproliferative glomerulonephritis (MsPGN and MPGN). The characteristics of the morphological changes were defined. In MsPGN with secondary hypertension (SH), nephronic wasting and hyalinosis of arteries were mostly detectable whereas MPGN with SH was primarily marked by the derangement of the tubulointerstitial structures. In MPGN, the levels of total and inactive renin (TR and IR) were significantly higher than in MsPGN. This can be regarded as risk factor of early development of SH. The content of TR and IR and in addition that of active renin (AR) in MRGN did not depend on the clinical form of chronic glomerulonephritis. As compared to MsPGN with an isolated urinary syndrome, in MsPGN with SH, AR was prevalent, while its level correlated well with systolic and the mean arterial pressure. AR may be implicated in the mechanism of SH in MsPGN. In MPGN with SH, kallikreinuria was found to be extremely low, which may be consequent to tubulointerstitial injuries. The discoordination of the renin-angiotensin and kallikrein system may be one of the causes of earlier formation and the grave course of SH in the morphological pattern under consideration.

摘要

对系膜增生性和膜增生性肾小球肾炎(MsPGN和MPGN)患者活体肾穿刺活检标本中的肾组织重构、肾素 - 血管紧张素 - 醛固酮以及激肽释放酶的合成功能进行了研究和比较。明确了形态学变化的特征。在伴有继发性高血压(SH)的MsPGN中,主要可检测到肾单位萎缩和动脉玻璃样变性,而伴有SH的MPGN主要表现为肾小管间质结构紊乱。在MPGN中,总肾素和无活性肾素(TR和IR)水平显著高于MsPGN。这可被视为SH早期发生的危险因素。MRGN中TR、IR以及活性肾素(AR)的含量不依赖于慢性肾小球肾炎的临床类型。与单纯性尿综合征的MsPGN相比,伴有SH的MsPGN中AR占优势,且其水平与收缩压和平均动脉压密切相关。AR可能参与了MsPGN中SH的发生机制。在伴有SH的MPGN中,发现激肽释放酶尿极低,这可能是肾小管间质损伤的结果。肾素 - 血管紧张素系统和激肽释放酶系统的失调可能是在所研究的形态学类型中SH较早形成和病情严重的原因之一。

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