Ledingham J G
J Hypertens Suppl. 1985 Nov;3(2):S33-5.
Hypertension in the malignant phase is all too commonly associated with impairment of renal function, which may be gross and dominate the clinical picture. In contrast, the vast majority of patients with essential hypertension show no evidence of impairment of renal function, despite the well recognized morbid anatomical changes of Renal haemodynamic changes can be detected in some two-thirds of hypertensive subjects with a variable decrease in renal blood flow and increase in filtration fraction. This pattern could be considered a potential mechanism for hyperfiltration damage to glomeruli, but there is no direct evidence. Estimates of renal blood flow and glomerular filtration rate are not sensitive indices of early renal damage of hypertensive origin. Much more sensitive but relatively unexplored is the measurement of micro-albuminuria in hypertensive patients. There is some evidence that the degree of micro-albuminuria may correlate inversely with the control of arterial pressure in essential hypertension. These observations and the suggestion that increased urinary N-acetyl-beta-D-glucosaminidase may be a sensitive index of renal tubular damage need further confirmation.
恶性高血压常常与肾功能损害相关，这种损害可能很严重并主导临床表现。相比之下，绝大多数原发性高血压患者并无肾功能损害的证据，尽管肾脏存在公认的病态解剖学变化。在大约三分之二的高血压患者中可检测到肾血流动力学变化，肾血流量有不同程度的减少，滤过分数增加。这种模式可被视为肾小球超滤损伤的潜在机制，但尚无直接证据。肾血流量和肾小球滤过率的估计值并非高血压所致早期肾损害的敏感指标。对于高血压患者，更为敏感但相对未被充分研究的是微量白蛋白尿的测定。有证据表明，在原发性高血压中，微量白蛋白尿的程度可能与动脉压的控制呈负相关。这些观察结果以及尿N-乙酰-β-D-氨基葡萄糖苷酶增加可能是肾小管损伤敏感指标的观点需要进一步证实。
