临床实践。肾动脉狭窄。
Clinical practice. Renal-artery stenosis.
作者信息
Dworkin Lance D, Cooper Christopher J
机构信息
Department of Medicine, Warren Alpert School of Brown University, Providence, USA.
出版信息
N Engl J Med. 2009 Nov 12;361(20):1972-8. doi: 10.1056/NEJMcp0809200.
Abstract
A 73-year-old former smoker with a history of hypertension and dyslipidemia presents to the emergency department with shortness of breath. His blood pressure is 160/75 mm Hg, heart rate 60 beats per minute, and respiratory rate 24 breaths per minute. Chest auscultation reveals diffuse rales, and there is 1+ pitting edema. The serum creatinine level is 1.4 mg per deciliter (124 µmol per liter) (estimated glomerular filtration rate, 52 ml per minute), and urinalysis shows 1+ protein. His condition improves after treatment with intravenous diuretics, but his systolic blood pressure remains elevated, at 170 mm Hg. Magnetic resonance angiography (MRA) reveals a diseased aorta, a high-grade ostial lesion of the left renal artery that is consistent with atherosclerotic stenosis, and a normal right renal artery. How should he be further evaluated and treated?
摘要
一名73岁有高血压和血脂异常病史的戒烟者因气短就诊于急诊科。他的血压为160/75 mmHg，心率60次/分钟，呼吸频率24次/分钟。胸部听诊发现弥漫性啰音，并有1+凹陷性水肿。血清肌酐水平为1.4 mg/dl（124 µmol/L）（估计肾小球滤过率为52 ml/分钟），尿液分析显示1+蛋白尿。经静脉利尿剂治疗后他的病情有所改善，但收缩压仍升高，为170 mmHg。磁共振血管造影（MRA）显示主动脉病变、左肾动脉起始部高度病变，符合动脉粥样硬化性狭窄，右肾动脉正常。应如何对他进行进一步评估和治疗？
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