Zech P, Pozet N, Sassard J
Nouv Presse Med. 1979 Jun 9;8(26):2173-6.
One hundred and eight patients suffering from hypertension due to a unilateral parenchymatous neophropathy were studied over a period of one to eight years after treatment was starded. The aetiologies were diverse: harmonious hypoplasia, segmental hypoplasia, pyelonephritis, reflux nephropathy, hydronephrosis and tuberculosis. Thirty nine patients were treated surgically, with 50% good results. In 82 cases medical treatment was continued for at least a year with a 52% success rate. Such success was recorded in 94% of cases in which beta-blockers were used (38 cases). Surgical success was not dependent upon the period for which hypertension had been present. The best results were seen in cases of hydronephrosis and pyelonephritis and the worst in tuberculosis. Thirteen patients underwent surgery event though there was no unilateral increase in plasma renin levels. Seven were improved or cured. Ten patients underwent surgery with a renin activity 50% greater than on the healthy side, 9 being improved or cured. Treatment with beta-blockers, alone or in association with diuretics, controlled blood pressure in 90% of cases, regardless of the renin activity. Plasma renin activity in the renal veins is of good prognostic value in terms of the effectiveness of nephrectomy against hypertension. In Call cases, beta-blockers were more effective than surgery.
108例因单侧实质性肾病导致高血压的患者在开始治疗后的1至8年期间接受了研究。病因多种多样:协调性发育不全、节段性发育不全、肾盂肾炎、反流性肾病、肾积水和结核病。39例患者接受了手术治疗,50%效果良好。82例患者持续接受药物治疗至少一年,成功率为52%。在使用β受体阻滞剂的38例病例中,94%取得了这样的成功。手术成功与否并不取决于高血压存在的时间。肾积水和肾盂肾炎病例的效果最佳,结核病病例的效果最差。13例患者尽管血浆肾素水平没有单侧升高仍接受了手术。7例病情改善或治愈。10例患者手术时肾素活性比健康侧高50%,9例病情改善或治愈。无论肾素活性如何,单独使用β受体阻滞剂或与利尿剂联合使用在90%的病例中可控制血压。肾静脉中的血浆肾素活性对于肾切除术治疗高血压的有效性具有良好的预后价值。在所有病例中,β受体阻滞剂比手术更有效。