Ribstein J, Mourad G, Argiles A, Mion C, Mimran A
Arch Mal Coeur Vaiss. 1986 Jun;79(6):929-32.
The activation of the renin angiotensin system is thought to be an important factor contributing to hypertension following kidney transplantation (TX). We studied 21 hypertensive renal transplant recipients, without evidence of acute graft rejection or transplant artery stenosis, 6 to 60 months post-TX. The acute responses of mean arterial pressure (MAP) and renal hemodynamics (ERPF: effective renal plasma flow, 131I-Hippuran clearance) and function (GFR: glomerular filtration rate, creatinine clearance; UNaV: urinary sodium excretion rate) to converting enzyme inhibition (CEI) by captopril were assessed. CEI induced a decrease in MAP (118 +/- 2 to 110 +/- 2 mmHg), renal resistance (RR: 0.27 +/- 0.02 to 0.21 +/- 0.01) and filtration fraction (FF: 0.31 +/- 0.02 to 0.23 +/- 0.01). ERPF (307 +/- 24 to 333 +/- 18 ml/min/1.73 m2) and GFR (88 +/- 5 to 78 +/- 5 ml/min/1.73 m2) were not significantly changed. UNaV increased by 53 +/- 24 mumol/min. Changes in MAP (r = -0.66), ERPF (r = 0.74) and FF (r = -0.88) were significantly correlated with the log of control plasma renin activity (PRA). In 10 patients with an increase of ERPF (range: + 30 to + 70%) and no change in GFR, the activated renin system could originate from the recipient's own kidneys. In the remaining 11 patients, CEI was associated with no increase in ERPF (change: + 2 to - 27%) and a fall in GFR, a response suggesting a possible intrarenal vascular damage. These results indicate that RAS participates in the regulation of systemic and renal vascular tone, with a possible predominant effect on efferent glomerular arteriole.
肾素血管紧张素系统的激活被认为是肾移植（TX）后导致高血压的一个重要因素。我们研究了21例高血压肾移植受者，这些患者在肾移植后6至60个月，没有急性移植肾排斥反应或移植肾动脉狭窄的证据。评估了平均动脉压（MAP）、肾血流动力学（ERPF：有效肾血浆流量，131I-马尿酸清除率）和功能（GFR：肾小球滤过率，肌酐清除率；UNaV：尿钠排泄率）对卡托普利转换酶抑制（CEI）的急性反应。CEI导致MAP（118±2至110±2 mmHg）、肾血管阻力（RR：0.27±0.02至0.21±0.01）和滤过分数（FF：0.31±0.02至0.23±0.01）降低。ERPF（307±24至333±18 ml/min/1.73 m2）和GFR（88±5至78±5 ml/min/1.73 m2）无显著变化。UNaV增加了53±24 μmol/min。MAP（r = -0.66）、ERPF（r = 0.74）和FF（r = -0.88）的变化与对照血浆肾素活性（PRA）的对数显著相关。在10例ERPF增加（范围：+30%至+70%）且GFR无变化的患者中，激活的肾素系统可能源于受者自身的肾脏。在其余11例患者中，CEI与ERPF无增加（变化：+2%至-27%）和GFR下降相关，这种反应提示可能存在肾内血管损伤。这些结果表明，肾素血管紧张素系统参与全身和肾血管张力的调节，可能对出球小动脉有主要作用。
