Shavit L, Reinus C, Slotki I
Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
Clin Nephrol. 2010 Feb;73(2):147-52. doi: 10.5414/cnp73147.
Malignant nephrosclerosis is acute renal failure in the setting of malignant hypertension and may be associated with thrombotic microangiopathy. Although the prognosis has improved considerably over the past decades, renal dysfunction remains an important cause of morbidity and mortality. Adequate control of blood pressure is crucial, allows gradual healing of the necrotizing vascular lesions and may induce stabilization and improvement of renal function in about 50 - 80% of involved patients. In addition, recent investigations have provided a better understanding of the pathophysiology of malignant hypertension and offer possibilities for identifying patients at risk. We report 3 patients who developed severe acute renal failure requiring dialysis initiation in the setting of malignant hypertension. All patients had kidney biopsy proven malignant nephrosclerosis and presented with symptoms of thrombotic microangiopathy. Despite adequate blood pressure control the prognosis of our patients varied.
恶性肾硬化症是恶性高血压背景下的急性肾衰竭，可能与血栓性微血管病相关。尽管在过去几十年中预后有了显著改善，但肾功能不全仍然是发病和死亡的重要原因。充分控制血压至关重要，可使坏死性血管病变逐渐愈合，并可能使约50% - 80%的受累患者肾功能稳定并改善。此外，最近的研究对恶性高血压的病理生理学有了更好的理解，并为识别高危患者提供了可能。我们报告3例在恶性高血压背景下发生严重急性肾衰竭需要开始透析的患者。所有患者均经肾活检证实为恶性肾硬化症，并出现血栓性微血管病症状。尽管血压得到了充分控制，但我们患者的预后各不相同。
