Palmer Biff F
Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8856, USA.
Am J Med Sci. 2004 Dec;328(6):330-43. doi: 10.1016/s0002-9629(15)33943-4.
The risk of developing chronic kidney disease in the setting of hypertension varies among patient populations. Black hypertensive patients have an increased risk of developing hypertension-induced chronic kidney disease even after taking into account socioeconomic factors. There is evidence to suggest that the kidney is intrinsically more susceptible to the damaging effects of hypertension in black patients. This susceptibility can be traced to disturbances in the way the kidney autoregulates. Impaired renal autoregulation may be the renal manifestation of a more widespread abnormality in endothelial function. Other conditions that can impair renal autoregulation and add to the risk of chronic kidney disease include low birth weight, obesity, insulin resistance, hyperuricemia, and hypercholesterolemia. To minimize the risk of chronic kidney disease in patients with impaired renal autoregulatory capability, strict blood pressure control is required. There is indirect evidence that blocking the renin-angiotensin system may improve renal autoregulation.
在高血压情况下发生慢性肾脏病的风险在不同患者群体中有所不同。即使考虑到社会经济因素，黑人高血压患者发生高血压诱导的慢性肾脏病的风险也会增加。有证据表明，黑人患者的肾脏本质上更容易受到高血压的损害作用。这种易感性可追溯到肾脏自身调节方式的紊乱。肾自身调节受损可能是内皮功能更广泛异常的肾脏表现。其他可损害肾自身调节并增加慢性肾脏病风险的情况包括低出生体重、肥胖、胰岛素抵抗、高尿酸血症和高胆固醇血症。为了将肾自身调节能力受损患者发生慢性肾脏病的风险降至最低，需要严格控制血压。有间接证据表明，阻断肾素 - 血管紧张素系统可能改善肾自身调节。
