Hörl W H
Klinischen Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Wien.
Wien Med Wochenschr. 1996;146(16):450-3.
Treatment with ACE inhibitors results in kidney protection due to reduction of systemic blood pressure, intraglomerular pressure, an antiproliferative effect, reduction of proteinuria and a lipid-lowering effect in proteinuric patients (secondary due to reduction of protein excretion). Elderly patients with diabetes melitus, coronary heart disease or peripheral vascular occlusion are at risk for deterioration of kidney function due to a high frequency of renal artery stenosis in these patients. In patients with renal insufficiency dose reduction of ACE inhibitors is necessary (exception: fosinopril) but more important is the risk for development of hyperkalemia. Patients at risk for renal artery stenosis and patients pretreated with diuretics should receive a low ACE inhibitor dosage initially ("start low - go slow"). For compliance reasons once daily ACE inhibitor dosage is recommended.
使用血管紧张素转换酶（ACE）抑制剂进行治疗可实现肾脏保护，这是由于其能降低全身血压、肾小球内压，具有抗增殖作用，减少蛋白尿，且对蛋白尿患者有降血脂作用（继发于蛋白质排泄减少）。患有糖尿病、冠心病或外周血管闭塞的老年患者，因其肾动脉狭窄发生率较高，存在肾功能恶化风险。对于肾功能不全患者，有必要减少ACE抑制剂的剂量（福辛普利为例外），但更重要的是存在高钾血症发生风险。有肾动脉狭窄风险的患者以及接受过利尿剂预处理的患者，初始应给予低剂量的ACE抑制剂（“起始量低，增量慢”）。出于依从性考虑，建议每日一次服用ACE抑制剂。
