Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, 75908 Paris Cedex 15, France.
Nat Rev Nephrol. 2010 Mar;6(3):151-9. doi: 10.1038/nrneph.2009.230. Epub 2010 Jan 26.
A reduction in the diameter of the renal arteries can lead to hypertension, renal dysfunction and/or pulmonary edema. About 90% of patients with renal artery stenosis have atherosclerosis, and 10% have fibromuscular dysplasia. Atherosclerotic renal artery stenosis is a common condition that typically occurs in patients at high risk of cardiovascular disease with coexistent vascular disease at nonrenal sites. Patients who undergo revascularization to treat hypertension associated with atherosclerotic stenosis need to continue medication with statins, antiplatelet agents and renin-angiotensin antagonists after the procedure to prevent renal and cardiovascular events. Two recent trials compared renal outcomes in patients with atherosclerotic stenosis who were treated with antihypertensive medication plus stenting with those in patients who were treated with medication alone. Available results favor a conservative approach (medication only) for most patients with atherosclerotic renal artery stenosis. These results, however, concern patients with stable clinical conditions and, in many cases, only moderate renal artery lesions. Blood pressure outcome after angioplasty is more favorable in patients with fibromuscular renal artery disease, who usually do not have renal failure, than in those with atherosclerosis.
肾动脉直径的减小可导致高血压、肾功能障碍和/或肺水肿。大约 90%的肾动脉狭窄患者有动脉粥样硬化，10%的患者有纤维肌性发育不良。动脉粥样硬化性肾动脉狭窄是一种常见疾病，通常发生在心血管疾病高危患者中，同时伴有非肾脏部位的血管疾病。为治疗与动脉粥样硬化性狭窄相关的高血压而进行血运重建的患者，在手术后需要继续使用他汀类药物、抗血小板药物和肾素-血管紧张素拮抗剂，以预防肾脏和心血管事件。最近两项试验比较了接受降压药物加支架置入治疗与仅接受药物治疗的动脉粥样硬化性狭窄患者的肾脏结局。现有结果倾向于对大多数动脉粥样硬化性肾动脉狭窄患者采取保守治疗（仅药物治疗）。然而，这些结果涉及临床状况稳定的患者，且在许多情况下仅涉及中度肾动脉病变。血管成形术后血压结果在纤维肌性肾血管疾病患者中更有利，这些患者通常没有肾衰竭，而在动脉粥样硬化患者中则不然。
