Ihm Chun-Gyoo
Division of Nephrology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea.
Electrolyte Blood Press. 2015 Dec;13(2):41-5. doi: 10.5049/EBP.2015.13.2.41. Epub 2015 Dec 30.
Chronic glomerulonephritis (GN), which includes focal segmental glomerulosclerosis and proliferative forms of GN such as IgA nephropathy, increases the risk of hypertension. Hypertension in chronic GN is primarily volume dependent, and this increase in blood volume is not related to the deterioration of renal function. Patients with chronic GN become salt sensitive as renal damage including arteriolosclerosis progresses and the consequent renal ischemia causes the stimulation of the intrarenal renin-angiotensin-aldosterone system(RAAS). Overactivity of the sympathetic nervous system also contributes to hypertension in chronic GN. According to the KDIGO guideline, the available evidence indicates that the target BP should be ≤140mmHg systolic and ≤90mmHg diastolic in chronic kidney disease patients without albuminuria. In most patients with an albumin excretion rate of ≥30mg/24 h (i.e., those with both micro-and macroalbuminuria), a lower target of ≤130mmHg systolic and ≤80mmHg diastolic is suggested. The use of agents that block the RAAS system is recommended or suggested in all patients with an albumin excretion rate of ≥30mg/ 24 h. The combination of a RAAS blockade with a calcium channel blocker and a diuretic may be effective in attaining the target BP, and in reducing the amount of urinary protein excretion in patients with chronic GN.
慢性肾小球肾炎（GN），包括局灶节段性肾小球硬化症以及增殖性GN形式，如IgA肾病，会增加患高血压的风险。慢性GN中的高血压主要取决于血容量，而血容量的增加与肾功能恶化无关。随着包括小动脉硬化在内的肾损伤进展，以及随之而来的肾缺血导致肾内肾素 - 血管紧张素 - 醛固酮系统（RAAS）受到刺激，慢性GN患者会变得对盐敏感。交感神经系统的过度活跃也会导致慢性GN患者出现高血压。根据KDIGO指南，现有证据表明，对于无蛋白尿慢性肾病患者，目标血压应为收缩压≤140mmHg和舒张压≤90mmHg。对于大多数白蛋白排泄率≥30mg/24小时的患者（即微量白蛋白尿和大量白蛋白尿患者），建议将目标血压降至更低，即收缩压≤130mmHg和舒张压≤80mmHg。对于所有白蛋白排泄率≥30mg/24小时的患者，建议使用阻断RAAS系统的药物。RAAS阻断剂与钙通道阻滞剂和利尿剂联合使用，可能有助于慢性GN患者达到目标血压，并减少尿蛋白排泄量。
