Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Hypertens Res. 2023 Feb;46(2):299-310. doi: 10.1038/s41440-022-01061-5. Epub 2022 Oct 12.
Chronic kidney disease (CKD) is one of the strongest risk factors for hypertension, and hypertension can exacerbate the progression of CKD. Thus, the management of CKD and antihypertensive therapy are inextricably linked. Research over the past decades has shown that the human kidney is more diverse than initially thought. Subjects with low nephron endowment are at increased risk of developing CKD and hypertension, which is consistent with the theory of the developmental origins of health and disease. Combined with other lifetime risks of CKD, hypertension may lead to a vicious cycle consisting of podocyte injury, glomerulosclerosis and further loss of nephrons. Of note, recent studies have shown that the number of nephrons correlates well with the number of podocytes, suggesting that these two components are intrinsically linked and may influence each other. Both nephrons and podocytes have no or very limited regenerative capacity and are destined to decrease throughout life. Therefore, one of the best strategies to slow the progression of CKD is to maintain the "numbers" of these essential components necessary to preserve renal function. To this end, both the achievement of an optimal blood pressure and a maximum reduction in urinary protein excretion are essential. Lifestyle modifications and antihypertensive drug therapy must be carefully individualized to address the potential diversity of the kidneys.
慢性肾脏病（CKD）是高血压最强的危险因素之一，而高血压可使 CKD 恶化。因此，CKD 的管理和降压治疗是紧密相关的。过去几十年的研究表明，人类肾脏比最初认为的更为多样化。肾单位储备不足的患者发生 CKD 和高血压的风险增加，这与健康和疾病的发育起源理论一致。再加上其他与 CKD 相关的终生风险因素，高血压可能导致一个恶性循环，包括足细胞损伤、肾小球硬化和进一步的肾单位损失。值得注意的是，最近的研究表明，肾单位的数量与足细胞的数量密切相关，这表明这两个组成部分内在相关，可能相互影响。肾单位和足细胞没有或仅有非常有限的再生能力，注定会随着生命的进程而减少。因此，减缓 CKD 进展的最佳策略之一是维持维持肾功能所必需的这些重要组成部分的“数量”。为此，实现最佳血压和最大程度降低尿蛋白排泄量都是至关重要的。必须仔细个体化生活方式改变和降压药物治疗，以解决肾脏潜在的多样性。
