Siamopoulos K, Sellars L, Mishra S C, Essenhigh D M, Robson V, Wilkinson R
Q J Med. 1983 Summer;52(207):349-62.
We report the experience of a regional centre serving a population of 3 millions in the management of patients with hypertension and unilateral scarred kidneys between 1972 and 1981. Thirty one patients were studied, fifteen have been subjected to nephrectomy and sixteen managed conservatively. The medically and surgically treated patients differed only in that the diseased kidney was smaller, 7.7 +/- 1.9 vs 9.9 +/- 1.7 cm, (p less than 0.01), and systolic blood pressure higher, 224 +/- 34 vs 198 +/- 30 mmHg, (p = 0.05), in the surgically treated group. Following nephrectomy blood pressure was normal without drugs in four patients, control was made easier in 10 patients and only one patient, who had bilateral disease, failed to benefit. In the non-surgical group drugs could be withdrawn in only one patient and control became easier in only five. Serum creatinine did not increase following nephrectomy, but had increased significantly at the time of the most recent follow up in the medically treated patients (89 +/- 20 to 102 +/- 32 mumol 1(-1), p less than 0.05). We conclude that nephrectomy is of value in the management of some patients with unilateral chronic pyelonephritis and need not result in loss of renal function. Renal vein renin studies may be helpful in selecting patients for surgery but examination of the effect of nephrectomy in patients without differences in renal vein renin is necessary to establish this.
我们报告了一个为300万人口服务的区域中心在1972年至1981年期间对高血压合并单侧瘢痕肾患者的管理经验。研究了31例患者，其中15例行肾切除术，16例采用保守治疗。接受药物治疗和手术治疗的患者之间的差异仅在于，手术治疗组中患病肾脏较小，分别为7.7±1.9 cm和9.9±1.7 cm，（p<0.01），收缩压较高，分别为224±34 mmHg和198±30 mmHg，（p = 0.05）。肾切除术后，4例患者血压在无药物情况下恢复正常，10例患者的血压控制变得更容易，只有1例患有双侧疾病的患者未从中受益。在非手术组中只有1例患者可以停用药物，只有5例患者的血压控制变得更容易。肾切除术后血清肌酐没有升高，但在药物治疗患者的最近一次随访时显著升高（从89±20升至102±32 μmol l-1，p<0.05）。我们得出结论，肾切除术对一些单侧慢性肾盂肾炎患者的治疗有价值，且不一定会导致肾功能丧失。肾静脉肾素研究可能有助于选择手术患者，但有必要检查肾静脉肾素无差异的患者肾切除术后的效果，以证实这一点。
