Hricik D E, Dunn M J
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.
J Am Soc Nephrol. 1990 Dec;1(6):845-58. doi: 10.1681/ASN.V16845.
Angiotensin-converting enzyme inhibitor-induced renal failure is now a well-recognized phenomenon that appears to occur almost exclusively in patients with a preexisting reduction in renal perfusion pressure, especially those with renovascular disease. In the latter group of patients, renal failure probably results from some combination of reduced poststenotic renal perfusion pressure and a unique disturbance in the autoregulation of glomerular filtration rate. Although traditionally regarded as functional and reversible, recent animal studies suggest that angiotensin-converting enzyme inhibitor-induced reductions of glomerular filtration rate may lead to progressive renal atrophy, an observation that raises concerns about the long-term safety of these agents in patients with renovascular disease. On the other hand, the deleterious consequences of angiotensin-converting enzyme inhibition in renovascular disease have been exploited as aids in the diagnosis of this disorder. Whether the adjunctive use of angiotensin-converting enzyme inhibitors will prove to be useful in screening large populations of hypertensive patients for renovascular hypertension remains to be determined. However, such adjunctive tests appear to be useful in judging the functional significance of angiographically documented renal artery stenosis.
血管紧张素转换酶抑制剂所致的肾衰竭目前是一种已得到充分认识的现象，几乎仅见于已有肾灌注压降低的患者，尤其是那些患有肾血管疾病的患者。在后者这类患者中，肾衰竭可能是由狭窄后肾灌注压降低与肾小球滤过率自身调节的独特紊乱的某种组合所致。尽管传统上认为其为功能性且可逆的，但最近的动物研究表明，血管紧张素转换酶抑制剂引起的肾小球滤过率降低可能导致进行性肾萎缩，这一观察结果引发了对这些药物在肾血管疾病患者中长期安全性的担忧。另一方面，血管紧张素转换酶抑制在肾血管疾病中的有害后果已被用于辅助诊断该疾病。血管紧张素转换酶抑制剂的辅助使用是否将被证明有助于在大量高血压患者中筛查肾血管性高血压仍有待确定。然而，此类辅助检查似乎有助于判断血管造影证实的肾动脉狭窄的功能意义。
