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肾病高血压的治疗。

Treatment of hypertension in renal disease.

作者信息

Baldwin D S, Neugarten J

出版信息

Am J Kidney Dis. 1985 Apr;5(4):A57-70. doi: 10.1016/s0272-6386(85)80067-6.

DOI:10.1016/s0272-6386(85)80067-6
PMID:3887904
Abstract

Experimental and clinical evidence are summarized that support the hypothesis that enhanced transmission of systemic hypertension to the adapted glomerulus in the setting of reduced nephron mass may be responsible for accelerated vascular and glomerular damage in the hypertensive stage of parenchymal renal disease in man. In experimental models of hypertension associated with reduced renal mass, the kidney appears to be damaged directly by transmission of pressure rather than primarily through vasoconstriction and ischemia. When hypertension is combined with models of glomerular disease, vascular and glomerular injury are aggravated. It is proposed that adaptive glomerular hemodynamic alterations which occur in parenchymal renal disease magnify the transmission of increased pressure and flows when hypertension supervenes. Accelerated vascular and glomerular damage and functional deterioration result. According to this hypothesis, control of systemic hypertension and minimization of hydraulic stress on the diseased glomerulus become critical to the management of chronic renal disease and the prevention of progressive renal insufficiency.

摘要

现总结实验和临床证据,这些证据支持以下假说:在肾单位数量减少的情况下,系统性高血压向适应性肾小球的增强传递可能是人实质性肾病高血压阶段血管和肾小球损伤加速的原因。在与肾质量减少相关的高血压实验模型中,肾脏似乎直接因压力传递而受损,而非主要通过血管收缩和缺血受损。当高血压与肾小球疾病模型相结合时,血管和肾小球损伤会加重。有人提出,实质性肾病中发生的适应性肾小球血流动力学改变会在高血压叠加时放大压力和血流增加的传递。从而导致血管和肾小球损伤加速以及功能恶化。根据这一假说,控制系统性高血压并将患病肾小球上的液压应力降至最低对于慢性肾病的管理和预防进行性肾功能不全至关重要。

相似文献

1
Treatment of hypertension in renal disease.肾病高血压的治疗。
Am J Kidney Dis. 1985 Apr;5(4):A57-70. doi: 10.1016/s0272-6386(85)80067-6.
2
Hypertension and renal diseases.高血压与肾脏疾病。
Am J Kidney Dis. 1987 Sep;10(3):186-91. doi: 10.1016/s0272-6386(87)80173-7.
3
Development of a Functional Glomerulus at the Organ Level on a Chip to Mimic Hypertensive Nephropathy.在芯片上构建具有功能的肾小球器官以模拟高血压肾病
Sci Rep. 2016 Aug 25;6:31771. doi: 10.1038/srep31771.
4
Systemic and glomerular hypertension and progression of chronic renal disease: the dilemma of nephrosclerosis.全身性和肾小球性高血压与慢性肾脏病的进展:肾硬化的困境
Kidney Int Suppl. 2005 Dec(99):S52-6. doi: 10.1111/j.1523-1755.2005.09910.x.
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Progression of chronic renal disease: role of systemic and glomerular hypertension.慢性肾病的进展:全身性高血压和肾小球高血压的作用
Am J Kidney Dis. 1989 Jun;13(6 Suppl 1):8-12.
6
Effects of calcium antagonists on glomerular hemodynamics and structure in experimental hypertension.钙拮抗剂对实验性高血压肾小球血流动力学及结构的影响。
Am J Kidney Dis. 1991 May;17(5 Suppl 1):89-93.
7
Blood pressure control in chronic kidney disease according to underlying renal disease: the Fukushima CKD cohort.根据基础肾脏疾病控制慢性肾脏病患者的血压:福岛慢性肾脏病队列研究。
Clin Exp Nephrol. 2020 May;24(5):427-434. doi: 10.1007/s10157-019-01838-y. Epub 2019 Dec 26.
8
ACE inhibition prevents and reverses L-NAME-exacerbated nephrosclerosis in spontaneously hypertensive rats.血管紧张素转换酶抑制剂可预防并逆转左旋精氨酸甲酯加重的自发性高血压大鼠肾硬化。
Hypertension. 1996 Feb;27(2):176-83. doi: 10.1161/01.hyp.27.2.176.
9
Nephrotoxic serum nephritis with hypertension: amelioration by antihypertensive therapy.
Kidney Int. 1985 Aug;28(2):135-9. doi: 10.1038/ki.1985.132.
10
Acute and long-term effects of ACE inhibition on renal haemodynamics in glomerular and interstitial nephropathies.血管紧张素转换酶抑制剂对肾小球和间质性肾病肾血流动力学的急性和长期影响。
J Renin Angiotensin Aldosterone Syst. 2002 Mar;3(1):40-5. doi: 10.3317/jraas.2002.007.

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