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[心肾相互作用]

[Cardio-renal interactions].

作者信息

Ito Sadayoshi

机构信息

Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University School of Medicine.

出版信息

Nihon Rinsho. 2012 Sep;70(9):1562-70.

Abstract

The renin-angiotensin-aldosterone system (RAAS) plays a crucial role in pathophysiology of kidney and cardiovascular disease, and their interactions. Clinical studies have demonstrated that RAAS inhibition reduces cardiovascular and renal events, particularly in patients with renal dysfunction. It may be assumed that impairment of renal function induces various injurious substances such as inflammation and oxidative molecules, which may activate RAAS, and RAAS, in turn, enhances inflammations and oxidative stress. Studies have shown that indices of renal protection, such as reductions of albuminuria, are closely associated with cardiovascular protection. In addition, decrements of renal function are also associated with worse prognosis. Inhibitors of RAAS decrease urinary albumin excretion but also reduce GFR. From the clinical point of view, the most appropriate antihypertensive regime would be the one that reduces albuminuria but maintain GFR.

摘要

肾素-血管紧张素-醛固酮系统(RAAS)在肾脏和心血管疾病的病理生理学及其相互作用中起着关键作用。临床研究表明,抑制RAAS可减少心血管和肾脏事件,尤其是在肾功能不全的患者中。可以推测,肾功能损害会诱导各种有害物质,如炎症和氧化分子,这些物质可能激活RAAS,而RAAS反过来又会加剧炎症和氧化应激。研究表明,肾脏保护指标,如蛋白尿的减少,与心血管保护密切相关。此外,肾功能下降也与较差的预后相关。RAAS抑制剂可减少尿白蛋白排泄,但也会降低肾小球滤过率(GFR)。从临床角度来看,最合适的抗高血压方案应该是既能减少蛋白尿又能维持GFR的方案。

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