Jensen G
Faculty of Medicine, Department of Nephrology, Sahlgrenska University Hospital, University of Göteborg, Sweden.
Scand J Urol Nephrol Suppl. 1995;170:1-78.
Renovascular hypertension (RVH) remains a leading cause of potentially curable hypertension. Although RVH affects less than 1% of the unselected hypertensive population, between 10% and 35% of appropriately screened patients referred to specialised centres for problematic hypertension may prove to have renovascular disease. Advances in percutaneous transluminal renal angioplasty (PTRA) have renewed interest in developing better noninvasive screening tests for identifying patients with potentially correctable hypertension or renal impairment due to renovascular disease caused by either fibromuscular dysplasia (FMD) or arteriosclerosis. Duplex ultrasound with the two-dimensional Echo-Colour-Doppler technique for measurements of blood flow velocities in the renal interlobar arteries as expressed in the Pulsatility Index (PI) has been evaluated. Experimentally induced changes in renovascular resistance (RVR) in normotensives and in primary hypertensives were registered noninvasively by means of PI-measurements. A significant correlation between the absolute values of PI and RVR was found in hypertensives (r = 0.50, p < 0.002), but not in normotensives. In both groups, the changes of RVR due to angiotensin II infusion and ACE-inhibition were significantly correlated to the changes in PI (normotensives: r = 0.69, p < 0.001, primary hypertensives: r = 0.64, p < 0.001). Normally, the blood flow velocities as expressed by the PI in the renal vasculature of the two kidneys are equal. In hypertensive patients, PI was lower in kidneys with significant renal artery stenosis (RAS) than in kidneys without RAS (p < 0.001). Doppler signals were absent in all kidneys with renal artery occlusion. A bilateral low PI combined with normal side difference in PI may in hypertensive patients indicate bilateral RAS. RVH was correctly diagnosed in 84% of the patients and the presence of RAS in 94%. Provocative testing of an activated renin-angiotensin system by means of an angiotensin converting enzyme inhibitor (ACEI) constitutes the foundation for screening for RVH using gamma camera renography with 99mTc-DTPA as a glomerular filtration marker. In 20 consecutive patients with successfully treated RVH, one-third of the patients were not correctly diagnosed using ACEI-enhanced 99mTc-DTPA gamma camera renography, which indicates that some patients with RVH have compensatory mechanisms to maintain GFR after ACE inhibition. The relationship between the renin-angiotensin system and erythropoietin (EPO) production was studied in 20 patients with RAS and hypertension.(ABSTRACT TRUNCATED AT 400 WORDS)
肾血管性高血压（RVH）仍然是潜在可治愈性高血压的主要病因。尽管RVH在未经选择的高血压人群中发病率低于1%，但在转诊至专门中心治疗难治性高血压的经过适当筛查的患者中，10%至35%可能被证实患有肾血管疾病。经皮腔内肾血管成形术（PTRA）的进展重新激发了人们对开发更好的非侵入性筛查试验的兴趣，以识别因纤维肌发育不良（FMD）或动脉硬化导致的肾血管疾病引起的潜在可纠正性高血压或肾功能损害患者。已经对采用二维回声 - 彩色多普勒技术的双功超声进行了评估，该技术用于测量肾叶间动脉中的血流速度，以搏动指数（PI）表示。通过PI测量以非侵入性方式记录了正常血压者和原发性高血压患者实验性诱导的肾血管阻力（RVR）变化。在高血压患者中发现PI绝对值与RVR之间存在显著相关性（r = 0.50，p < 0.002），而在正常血压者中未发现这种相关性。在两组中，由于输注血管紧张素II和使用血管紧张素转换酶抑制剂（ACEI）导致的RVR变化与PI变化显著相关（正常血压者：r = 0.69，p < 0.001，原发性高血压患者：r = 0.64，p < 0.001）。正常情况下，用PI表示的两肾肾血管系统中的血流速度是相等的。在高血压患者中，存在明显肾动脉狭窄（RAS）的肾脏的PI低于无RAS的肾脏（p < 0.001）。所有肾动脉闭塞的肾脏均未检测到多普勒信号。高血压患者双侧低PI且PI的侧别差异正常可能提示双侧RAS。84%的患者被正确诊断为RVH，94%的患者被发现存在RAS。通过使用血管紧张素转换酶抑制剂（ACEI）激发激活的肾素 - 血管紧张素系统，构成了以99mTc - DTPA作为肾小球滤过标记物的γ相机肾图筛查RVH的基础。在连续20例成功治疗的RVH患者中，三分之一的患者使用ACEI增强的99mTc - DTPAγ相机肾图未被正确诊断，这表明一些RVH患者在ACE抑制后具有维持肾小球滤过率（GFR）的代偿机制。在20例患有RAS和高血压的患者中研究了肾素 - 血管紧张素系统与促红细胞生成素（EPO）产生之间的关系。（摘要截选至400字）
