Del Vecchio Lucia, Procaccio Mirella, Viganò Sara, Cusi Daniele
Graduate School of Nephrology, University of Milan, Milan, Italy.
Nat Clin Pract Nephrol. 2007 Jan;3(1):42-9. doi: 10.1038/ncpneph0362.
In the past 10 years, many widely accepted concepts relating to aldosterone production and its pathogenetic role have changed. We now know that aldosterone is produced not only by the zona glomerulosa of the adrenal cortex, but also in the heart, blood vessels, kidney and brain; such extra-epithelial production occurs mainly during tissue repair. Also, increased aldosterone levels contribute to vessel inflammation, oxidative stress, endothelial dysfunction and organ damage. As such, aldosterone has a key role in the development of myocardial fibrosis. Anti-aldosterone treatment has proven effective in patients with heart failure. Experimental evidence regarding the role of aldosterone in kidney damage has accumulated. Aldosterone infusion can counteract the beneficial effects of treatment with angiotensin-converting-enzyme inhibitors, causing more-severe proteinuria and an increased number of vascular and glomerular lesions; treatment with aldosterone antagonists can reverse these alterations. Preliminary observations in pilot studies in humans confirm the experimental findings, supporting the hypothesis that aldosterone antagonists are renoprotective in clinical practice. Studies in larger populations with longer follow-up are needed to confirm this theory.
在过去10年里，许多与醛固酮生成及其致病作用相关的被广泛接受的概念已经发生了变化。我们现在知道，醛固酮不仅由肾上腺皮质球状带产生，也在心脏、血管、肾脏和大脑中产生；这种上皮外生成主要发生在组织修复过程中。此外，醛固酮水平升高会导致血管炎症、氧化应激、内皮功能障碍和器官损伤。因此，醛固酮在心肌纤维化的发展中起关键作用。抗醛固酮治疗已被证明对心力衰竭患者有效。关于醛固酮在肾损伤中作用的实验证据不断积累。输注醛固酮可抵消血管紧张素转换酶抑制剂治疗的有益作用，导致更严重的蛋白尿以及血管和肾小球病变数量增加；使用醛固酮拮抗剂治疗可逆转这些改变。在人类初步研究中的观察结果证实了实验发现，支持醛固酮拮抗剂在临床实践中具有肾脏保护作用这一假说。需要在更大规模人群中进行更长时间随访的研究来证实这一理论。
