Anderson S
Renal Division, Brigham and Women's Hospital, Boston, MA 02115.
Hypertension. 1991 Mar;17(3):288-95. doi: 10.1161/01.hyp.17.3.288.
The intrarenal hemodynamic effects of antihypertensive agents vary considerably, and these microcirculatory effects may contribute to long-term structural sequelae in the setting of chronic renal disease. To investigate the consequences of blood pressure reduction with calcium antagonists, 5/6 nephrectomized Munich-Wistar rats underwent baseline determinations of mean arterial pressure, whole kidney function, and single nephron glomerular filtration rate, after which intravenous infusions of verapamil or diltiazem were given in doses that acutely normalized blood pressure; control rats received saline vehicle. During the baseline period, all rats exhibited comparably elevated values for mean arterial pressure and single nephron glomerular filtration rate. During the experimental infusion, control rats exhibited continued single nephron hyperfiltration (84 +/- 8 nl/min) as a result of elevations in both glomerular capillary plasma flow rate (330 +/- 36 nl/min) and glomerular capillary hydraulic pressure (68 +/- 3 mm Hg), whereas the glomerular capillary ultrafiltration coefficient was low [0.050 +/- 0.009 nl/(sec.mm Hg)]. Both verapamil (148 +/- 6 to 103 +/- 3 mm Hg, p less than 0.05) and diltiazem (154 +/- 6 to 102 +/- 2 mm Hg, p less than 0.05) normalized arterial pressure, which did not change in control rats (150 +/- 7 to 142 +/- 8 mm Hg). Single nephron hyperfiltration and hyperperfusion were comparable among groups during the experimental period; compared with baseline values, diltiazem (97 +/- 8 to 71 +/- 7 nl/min, p less than 0.05) but not verapamil (90 +/- 7 to 83 +/- 6 nl/min, p = NS) modestly lowered the single nephron glomerular filtration rate.(ABSTRACT TRUNCATED AT 250 WORDS)
抗高血压药物对肾内血流动力学的影响差异很大,在慢性肾病情况下,这些微循环效应可能导致长期的结构后遗症。为了研究钙拮抗剂降低血压的后果,对5/6肾切除的慕尼黑-维斯塔尔大鼠进行了平均动脉压、全肾功能和单肾单位肾小球滤过率的基线测定,之后静脉输注维拉帕米或地尔硫䓬,剂量能使血压急性恢复正常;对照大鼠给予生理盐水。在基线期,所有大鼠的平均动脉压和单肾单位肾小球滤过率值均显著升高。在实验输注期间,对照大鼠由于肾小球毛细血管血浆流速(330±36 nl/min)和肾小球毛细血管液压(68±3 mmHg)升高,持续出现单肾单位超滤过(84±8 nl/min),而肾小球毛细血管超滤系数较低[0.050±0.009 nl/(sec·mmHg)]。维拉帕米(148±6至103±3 mmHg,p<0.05)和地尔硫䓬(154±6至102±2 mmHg,p<0.05)均使动脉压恢复正常,对照大鼠的动脉压无变化(150±7至142±8 mmHg)。实验期间各组的单肾单位超滤过和高灌注情况相当;与基线值相比,地尔硫䓬(97±8至71±7 nl/min,p<0.05)使单肾单位肾小球滤过率略有降低,而维拉帕米(90±7至83±6 nl/min,p=无显著性差异)则未使其降低。(摘要截短至250字)