Materson B J
Am J Kidney Dis. 1987 Jul;10(1 Suppl 1):88-93.
Plasma renin activity (PRA) is markedly increased by captopril. There is not enough separation between the changes in PRA of patients with renal artery stenosis (RAS) to separate them reliably from those with essential hypertension. A minimal response may suggest primary aldosteronism. Captopril does increase the ratio of PRA in the venous blood from a kidney with RAS to that of the contralateral kidney. Captopril, 25 to 50 mg orally, given before renal vein PRA sampling will increase the sensitivity and specificity of the test. Treatment with current antihypertensive drugs need not be discontinued. Scleroderma renal crisis (SRC) used to be uniformly lethal within a few months. Modern, aggressive antihypertensive therapy has made survival of 2 or more years common. Not all patients respond, and some progress to renal failure despite good BP control. Captopril has been used with success in some patients with idiopathic edema. In conclusion, captopril markedly enhances the accuracy of renal vein renin assay for the diagnosis of RAS and is of major value in the treatment of SRC.
卡托普利可使血浆肾素活性（PRA）显著升高。肾动脉狭窄（RAS）患者PRA的变化与原发性高血压患者的变化之间没有足够的差异，无法可靠地将两者区分开来。最小反应可能提示原发性醛固酮增多症。卡托普利确实会增加患RAS的一侧肾脏静脉血中PRA与对侧肾脏PRA的比值。在肾静脉PRA采样前口服25至50毫克卡托普利，会提高该检测的敏感性和特异性。目前的抗高血压药物治疗无需停药。硬皮病肾危象（SRC）过去在几个月内通常是致命的。现代积极的抗高血压治疗使患者存活2年或更长时间变得常见。并非所有患者都有反应，一些患者尽管血压控制良好仍会进展为肾衰竭。卡托普利已成功用于一些特发性水肿患者。总之，卡托普利显著提高了肾静脉肾素测定对RAS诊断的准确性，在SRC治疗中具有重要价值。
