Kerut Edmund Kenneth, Geraci Stephen A, Falterman Chester, Hunter David, Hanawalt Curtis, Giles Thomas D
Heart Clinic of Louisiana, Marrero, 70072, USA.
J Clin Hypertens (Greenwich). 2006 Jul;8(7):502-9. doi: 10.1111/j.1524-6175.2006.05442.x.
Atherosclerotic renal artery stenosis (RAS) is relatively common and often associated with reversible hypertension, progressive renal insufficiency, and/or coronary-independent pulmonary edema. Not all RAS is associated with renovascular hypertension. Historical and physical findings may suggest renovascular hypertension and warrant investigation for RAS. Noninvasive diagnostic imaging options include renal artery duplex ultrasonography, magnetic resonance angiography, computed tomographic angiography, and CO2 angiography, with each method having its own advantages and limitations. Functional tests of renal flow, which characterize RAS significance, include captopril-stimulated plasma renin activity and captopril renography. To date, no single approach has shown clear superiority either in diagnosis or identification of patients most likely to benefit from revascularization. Revascularization of RAS is recommended for severe/drug-refractory hypertension, preservation of renal function, recurrent flash pulmonary edema, or recurrent severe heart failure. Intervention response is variable, but the ongoing Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, comparing medical therapy with and without stenting, should provide management guidance.
动脉粥样硬化性肾动脉狭窄（RAS）相对常见，常与可逆性高血压、进行性肾功能不全和/或冠状动脉无关的肺水肿相关。并非所有RAS都与肾血管性高血压相关。病史和体格检查结果可能提示肾血管性高血压，因此有必要对RAS进行调查。非侵入性诊断成像方法包括肾动脉双功超声、磁共振血管造影、计算机断层血管造影和二氧化碳血管造影，每种方法都有其自身的优缺点。表征RAS严重程度的肾血流功能测试包括卡托普利刺激的血浆肾素活性和卡托普利肾图。迄今为止，在诊断或识别最有可能从血运重建中获益的患者方面，尚无单一方法显示出明显优势。对于严重/药物难治性高血压、肾功能的保留、复发性闪发性肺水肿或复发性严重心力衰竭，建议对RAS进行血运重建。干预反应各不相同，但正在进行的肾动脉粥样硬化病变心血管结局（CORAL）试验，比较了有或没有支架置入的药物治疗，应该能提供管理指导。
