Halimi J M, Ribstein J, Mimran A
Service de Médecine Interne et Hypertension Artérielle, Hôpital Lapeyronie, Montpellier.
J Mal Vasc. 1995;20(4):241-6.
Renovascular disease is the leading cause of surgically-curable arterial hypertension and one of the few cause of reversible chronic renal failure, but its exact prevalence remains unknown. Progression of atheromatous disease occurs in 50% of cases and it may result in bilateral stenosis (25%) or total occlusion (15%). By now, the main aim of renal revascularization is retrieval of impaired function or prevention of renal failure rather than control of hypertension. However, renal functional deterioration may result from cholesterol embolism or glomerulosclerosis in addition to ischemia. Correction of post-proximal stenosis is obtained by both surgery and percutaneous angioplasty. In favor of angioplasty are a higher acceptability and a modestly better cost-benefit ratio. Surgery may be preferred when the stenosis is proximal, complex or associated with aortic disease; in addition, analysis of published (mostly uncontrolled) series suggest that beneficial renal functional outcome is slightly better following surgery. Importantly, both diagnosis and prognosis of ischemic nephropathy are difficult to establish. Various predictors of recovery (renal size, renal vein renin ratio, alteration in scintigrams, angiography or biopsy) were shown to fail on an individual basis. Further controlled studies based on reliable methods of measuring renal function are warranted.
肾血管疾病是外科可治愈的动脉高血压的主要原因，也是可逆性慢性肾衰竭的少数病因之一，但其确切患病率仍然未知。动脉粥样硬化疾病在50%的病例中会进展，可能导致双侧狭窄（25%）或完全闭塞（15%）。目前，肾血管重建的主要目的是恢复受损功能或预防肾衰竭，而非控制高血压。然而，除缺血外，胆固醇栓塞或肾小球硬化也可能导致肾功能恶化。近端狭窄矫正可通过手术和经皮血管成形术实现。血管成形术的优势在于更高的可接受性和适度更好的成本效益比。当狭窄位于近端、复杂或与主动脉疾病相关时，可能更倾向于手术；此外，对已发表（大多为非对照）系列研究的分析表明，手术后有益的肾功能结果略好。重要的是，缺血性肾病的诊断和预后都难以确定。各种恢复预测指标（肾大小、肾静脉肾素比值、闪烁扫描、血管造影或活检的改变）在个体情况下均显示无效。有必要基于可靠的肾功能测量方法进行进一步的对照研究。
