Rasmussen S, Ibsen H, Giese J
a From the Departments of Clinical Physiology and Internal Medicine C , Glostrup Hospital , Copenhagen , Denmark.
Scand J Urol Nephrol. 1984 Jul;18(sup79):49-52. doi: 10.1080/00365599.1984.11783715.
In three unilaterally nephrectomized patients with a poorly functioning remaining kidney, a reversible decrease of glomerular filtration rate (GFR) was observed during treatment with captopril. Only modest decreases in blood pressure ocurred. In four patients with various forms of malignant hypertension and impairment of renal function, GFR remained unchanged or even increased when the blood pressure was reduced by captopril. All patients had increased plasma concentrations of renin and angio-tension II prior to captopril. We hypothesize that an activation of the renin-angiotensin system in hypertensive patients with reduced GFR may either reflect a compensatory mechanism aiming at maintaining renal function, or imply an excessive angiotensin-mediated vasoconstriction causing a decrease in renal function. The use of angiotensin converting enzyme inhibitors may be damaging for renal function in the first situation and beneficial in the second.
在3例单侧肾切除且剩余肾脏功能不佳的患者中，使用卡托普利治疗期间观察到肾小球滤过率（GFR）出现可逆性下降。血压仅出现适度下降。在4例患有各种形式恶性高血压且肾功能受损的患者中，当用卡托普利降低血压时，GFR保持不变甚至升高。所有患者在使用卡托普利之前血浆肾素和血管紧张素II浓度均升高。我们推测，GFR降低的高血压患者肾素-血管紧张素系统的激活可能要么反映了旨在维持肾功能的一种代偿机制，要么意味着血管紧张素介导的过度血管收缩导致肾功能下降。在第一种情况下使用血管紧张素转换酶抑制剂可能对肾功能有损害，而在第二种情况下则有益。
