Kimura G, London G M, Safar M E, Kuramochi M, Omae T
Department of Medicine, National Cardiovascular Center, Osaka, Japan.
Kidney Int. 1991 May;39(5):966-72. doi: 10.1038/ki.1991.122.
Split intrarenal hemodynamics in stenotic and contralateral kidneys of unilateral renovascular hypertension (RVH) were estimated by Gomez's formulae. Forty patients with essential hypertension and 40 patients with RVH were studied. Split para-amino hippurate and inulin clearances were measured by ureteral catheterization as indexes for effective renal plasma flow and glomerular filtration rates, allowing the estimation of intrarenal hemodynamics such as afferent arteriolar resistance (RA), efferent arteriolar resistance (RE) and glomerular hydrostatic pressure (PG) in each kidney. Normal values of intrarenal hemodynamic parameters were obtained in 24 normotensive subjects without ureteral catheterization, assuming each kidney had the half function of both kidneys. Systemic mean arterial pressure did not differ between essential and renovascular hypertension (141 +/- 3 vs. 148 +/- 3 mm Hg). Effective renal plasma flow and glomerular filtration rates were decreased in the stenotic kidney of RVH (98 +/- 8, 24 +/- 2 ml/min/m2), while increased in the contralateral kidney (195 +/- 11, 48 +/- 2), compared with the right kidney of essential hypertension (162 +/- 8, 33 +/- 1). Although effective renal plasma flow rate was not different from normal (191 +/- 8), glomerular filtration rate was significantly higher in the contralateral kidney of RVH than in normal (38 +/- 1). RA was elevated due to the stenotic lesion in the stenotic kidney (28,500 +/- 1,900 dyns.sec.cm-5), while the elevation in the contralateral kidney (10,800 +/- 600) was less than in the right kidney of essential hypertension (14,900 +/- 1,200). RE (5,800 +/- 300) in both kidneys of RVH was higher than in the right kidney of essential hypertension (4,500 +/- 200).(ABSTRACT TRUNCATED AT 250 WORDS)
采用戈麦斯公式估算单侧肾血管性高血压(RVH)狭窄肾脏及对侧肾脏的肾内血流动力学情况。研究了40例原发性高血压患者和40例RVH患者。通过输尿管插管测量对氨基马尿酸和菊粉清除率,作为有效肾血浆流量和肾小球滤过率的指标,从而估算每个肾脏的肾内血流动力学,如入球小动脉阻力(RA)、出球小动脉阻力(RE)和肾小球静水压(PG)。在24例未行输尿管插管的血压正常受试者中获得肾内血流动力学参数的正常值,假定每个肾脏具有双侧肾脏一半的功能。原发性高血压和肾血管性高血压患者的全身平均动脉压无差异(141±3 vs. 148±3 mmHg)。与原发性高血压患者右侧肾脏(162±8, 33±1)相比,RVH狭窄肾脏的有效肾血浆流量和肾小球滤过率降低(98±8, 24±2 ml/min/m2),而对侧肾脏升高(195±11, 48±2)。虽然有效肾血浆流量率与正常无差异(191±8),但RVH对侧肾脏的肾小球滤过率显著高于正常(38±1)。狭窄肾脏因狭窄病变导致RA升高(28,500±1,900 dyns.sec.cm-5),而对侧肾脏的升高(10,800±600)低于原发性高血压患者右侧肾脏(14,900±1,200)。RVH双侧肾脏的RE(5,800±300)高于原发性高血压患者右侧肾脏(4,500±200)。(摘要截断于250字)
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