Geyskes G G, Oei H Y, Klinge J, Kooiker C J, Puylaert C B, Dorhout Mees E J
Department of Nephrology and Hypertension, University Hospital, Utrecht, The Netherlands.
Q J Med. 1988 Mar;66(251):203-17.
We report the results of treatment in 57 patients with renovascular hypertension associated with one poorly perfused, small kidney with less than 25 per cent of total 131I-hippurate uptake shown by renography. Arteriography in 29 patients demonstrated occlusion of the artery of the small kidney, and in 28 there was stenosis. In addition, 25 patients had stenosis of the artery supplying the larger contralateral kidney. Stenosis of the arteries of the contralateral kidneys was dilated by percutaneous transluminal arterioplasty in all but one of the 25 patients with bilateral disease of the artery, stenosis of the small kidney could be dilated successfully by percutaneous transluminal arterioplasty in 22 of the 28 patients, and cure or improvement of blood pressure was achieved in 12 of them. Percutaneous transluminal arterioplasty of occluded arteries was generally unsuccessful. In 17 patients with unilateral disease not manageable by percutaneous transluminal arterioplasty, nephrectomy of the small kidney improved blood pressure control without significant deterioration of renal function. Renal function improved in 10 patients with bilateral lesions treated by nephrectomy of the small kidney in combination with contralateral percutaneous transluminal arterioplasty. Histological examination of excised kidneys showed large infarcts or several cholesterol emboli whether percutaneous transluminal arterioplasty had been attempted or not. After observation periods ranging from two to 79 months, 48 patients were normotensive (21 without and 27 with medication) and nine patients were still hypertensive even with medication. This study showed that by using percutaneous transluminal arterioplasty initially if possible, supplemented with nephrectomy and/or medication, normotension without loss of renal function or immediate serious complications could be obtained in the majority of these severely hypertensive patients.
我们报告了57例肾血管性高血压患者的治疗结果，这些患者伴有一个灌注不良的小肾脏，肾图显示该小肾脏的碘-131马尿酸盐摄取量不到总量的25%。29例患者的血管造影显示小肾脏的动脉闭塞，28例显示有狭窄。此外，25例患者对侧较大肾脏的供血动脉有狭窄。在25例双侧动脉疾病患者中，除1例之外，其余患者对侧肾脏动脉的狭窄均通过经皮腔内血管成形术进行了扩张；28例小肾脏动脉狭窄患者中，有22例通过经皮腔内血管成形术成功扩张，其中12例患者的血压得到治愈或改善。经皮腔内血管成形术治疗闭塞动脉通常不成功。在17例无法通过经皮腔内血管成形术治疗的单侧疾病患者中，切除小肾脏改善了血压控制，且肾功能未出现明显恶化。10例双侧病变患者通过切除小肾脏并结合对侧经皮腔内血管成形术进行治疗，肾功能得到改善。切除肾脏的组织学检查显示，无论是否尝试过经皮腔内血管成形术，均有大面积梗死或多个胆固醇栓子。经过2至79个月的观察期后，48例患者血压正常（21例未用药，27例用药），9例患者即使用药仍为高血压。本研究表明，对于这些重度高血压患者，若可能，最初采用经皮腔内血管成形术，并辅以肾切除术和/或药物治疗，大多数患者可实现血压正常，且不丧失肾功能或出现即刻严重并发症。
