Mann J
Medizinische Abteilung, Städtisches Klinikum Schwabing, München.
Ther Umsch. 1994 Dec;51(12):819-23.
Ischemic nephropathy encompasses renal insufficiency due to 3 different diseases, namely renal artery stenosis, so-called benign nephrosclerosis, and renal cholesterol embolism. All 3 disease entities may lead to a progressive loss of renal excretory function. If a patient presents with renal failure of unknown origin, renal artery stenosis should be looked for by color-coded duplex scanning or arteriography. The clinical presentation of benign nephrosclerosis in caucasians has no typical clues. Usually, a renal biopsy identifies this renal disorder in a patient with long-standing hypertension, moderate proteinuria and renal insufficiency. Cholesterol embolism typically affects several arterial trees, and is induced by arteriography in patients with arteriosclerosis of the aorta. The best treatment for ischemic nephropathy due to renal artery stenosis [conservative, angioplasty, surgery] is unknown because appropriately controlled trials are lacking. Invasive therapy should be considered in patients with bilateral renal artery stenosis or stenosis of a single functioning kidney, particularly if the affected kidney is not contracted. Arguments in favor of invasive therapy include the progressive nature of renal artery stenosis and the poor outcome of dialysis patients with this diagnosis as underlying renal disease.
缺血性肾病包括由三种不同疾病导致的肾功能不全，即肾动脉狭窄、所谓的良性肾硬化症和肾胆固醇栓塞。所有这三种疾病实体都可能导致肾排泄功能的逐渐丧失。如果患者出现不明原因的肾衰竭，应通过彩色编码双功扫描或血管造影来查找肾动脉狭窄。白种人中良性肾硬化症的临床表现没有典型线索。通常，肾活检可在患有长期高血压、中度蛋白尿和肾功能不全的患者中确诊这种肾脏疾病。胆固醇栓塞通常累及多个动脉分支，由主动脉硬化患者的血管造影诱发。由于缺乏适当的对照试验，肾动脉狭窄所致缺血性肾病的最佳治疗方法（保守治疗、血管成形术、手术）尚不清楚。双侧肾动脉狭窄或单个功能肾狭窄的患者应考虑进行侵入性治疗，特别是如果患肾没有萎缩。支持侵入性治疗的理由包括肾动脉狭窄的进行性本质以及以此诊断为潜在肾病的透析患者的不良预后。
