Ie E H, Karschner J K, Shapiro A P
Department of Medicine, Shadyside Hospital, University of Pittsburgh School of Medicine, PA 15232, USA.
Neth J Med. 1995 Mar;46(3):136-41. doi: 10.1016/0300-2977(94)00061-d.
Unilateral renal artery stenosis can lead to a non-functional kidney which secretes large amounts of renin. Four cases are presented in which the high renin state resulted in hypertension, proteinuria from the intact contralateral kidney, and secondary aldosteronism. The proteinuria was in the nephrotic range, which is unusual in renovascular hypertension, but gradually disappeared after correction of the high renin state by removal of the renin-secreting kidney or administration of an ACE inhibitor. Accordingly, when there is marked proteinuria in the presence of new-onset or rapidly progressive hypertension, hypokalaemic alkalosis, and a high peripheral PRA, renal artery stenosis should be considered since the proteinuria may be reversible after nephrectomy, repair of the ischaemic kidney or medical therapy.
单侧肾动脉狭窄可导致一个无功能的肾脏，该肾脏会分泌大量肾素。本文介绍了4例病例，其中高肾素状态导致了高血压、健侧对侧肾脏出现蛋白尿以及继发性醛固酮增多症。蛋白尿处于肾病范围，这在肾血管性高血压中并不常见，但在通过切除分泌肾素的肾脏或给予血管紧张素转换酶抑制剂纠正高肾素状态后逐渐消失。因此，当新发或快速进展性高血压、低钾性碱中毒和高外周血浆肾素活性（PRA）伴有明显蛋白尿时，应考虑肾动脉狭窄，因为蛋白尿在肾切除、缺血性肾脏修复或药物治疗后可能是可逆的。
