Voiculescu A, Rump L C
Klinik für Nephrologie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf.
Internist (Berl). 2009 Jan;50(1):42-50. doi: 10.1007/s00108-008-2198-5.
Renal artery stenosis (RAS) is often present in patients with severe hypertension and atherosclerotic vascular disease. In this setting it is important to screen patients for renovascular disease, e.g. with Duplex-ultrasound, CT- or MR-angiography. The challenge of treating these patients is to find the evidence proving that the RAS is responsible for hypertension and/or renal dysfunction. Measurement of the intra-arterial pressure gradient is necessary in order to determine hemodynamic relevance. On the other side, in these patients hypertension is often of primary and/or renoparenchymatous origin and is aggravated by a renovascular disease. This explains why hypertension cannot be cured even if a high grade stenosis has been removed. In addition, thromb- and cholesterol-embolic material is often mobilized during an invasive procedure and leads to renaparenchymatous ischemia which sustains hypertension after intervention. An individual evaluation of profit versus risk is important for the decision for or against an invasive procedure, especially since there is no sufficient evidence for a decrease of mortality after interventions of RAS. The optimal conservative treatment, including the treatment of atherosclerotic risk factors is recommended.
肾动脉狭窄（RAS）常出现在患有严重高血压和动脉粥样硬化性血管疾病的患者中。在这种情况下，对患者进行肾血管疾病筛查很重要，例如使用双功超声、CT血管造影或磁共振血管造影。治疗这些患者的挑战在于找到证据证明RAS是高血压和/或肾功能不全的病因。为了确定血流动力学相关性，测量动脉内压力梯度是必要的。另一方面，在这些患者中，高血压通常是原发性和/或肾实质源性的，并因肾血管疾病而加重。这就解释了为什么即使去除了高度狭窄，高血压也无法治愈。此外，在侵入性操作过程中，血栓和胆固醇栓塞物质常被激活，导致肾实质缺血，从而在干预后持续存在高血压。对获益与风险进行个体化评估对于决定是否进行侵入性操作很重要，特别是因为没有足够的证据表明RAS干预后死亡率会降低。建议采用最佳的保守治疗，包括治疗动脉粥样硬化风险因素。
