Monhart V
III. interní oddelení Ustrední vojenské nemocnice, Praha.
Vnitr Lek. 2004 Jul;50(7):531-6.
A characteristic feature of a majority of chronic renal diseases is their progressive course. The speed of deterioration of renal function depends besides an aetiology of a primary disease on the level of systemic (and glomerular) blood pressure and a degree of proteinuria. Angiotensin II plays an important role in the use of hemodynamic and nonhemodynamic factors of progression. Inhibitors of angiotensin converting enzyme or angiotensin antagonists comparable with other hypertensives used in blood pressure control have more substantial renoprotective effects both in diabetic and nondiabetic kidney diseases. A prerequisite of an effective renal protection is reaching the target blood pressure corresponding with present European and American recommended values < or = 130/80 mm Hg. The least risk of chronic renal disease progression is when systolic blood pressure is 110-120 mm Hg and in proteinuria plain 1 g/24 hod. A practical implementation of renal protection is difficult in patients with renal insufficiency in spite of the used combination of angiotensin converting enzyme inhibitors or angiotensin antagonists and other antihypertensives.
大多数慢性肾脏疾病的一个特征是其病程呈进行性。肾功能恶化的速度除了取决于原发性疾病的病因外，还取决于全身（及肾小球）血压水平和蛋白尿程度。血管紧张素II在进展的血流动力学和非血流动力学因素的作用中起重要作用。与用于控制血压的其他高血压药物相比，血管紧张素转换酶抑制剂或血管紧张素拮抗剂在糖尿病和非糖尿病肾病中具有更显著的肾脏保护作用。有效的肾脏保护的一个前提是达到与当前欧美推荐值相符的目标血压<或=130/80 mmHg。当收缩压为110 - 120 mmHg且蛋白尿<1 g/24小时时，慢性肾脏疾病进展的风险最小。尽管使用了血管紧张素转换酶抑制剂或血管紧张素拮抗剂与其他抗高血压药物的联合治疗，但对于肾功能不全的患者，肾脏保护的实际实施仍很困难。
