Khairullah Q T, Somers D L, Aktay R
University of Iowa Hospitals and Clinics, Iowa City, USA.
Am Fam Physician. 1997 May 1;55(6):2240-4.
Renovascular disease is a common cause of secondary hypertension. Renal artery stenosis is present in up to one third of patients with clinical markers suggestive of renovascular hypertension, such as hypertension refractory to medical management, severe hypertension in a young patient and worsening of renal function after the use of an angiotensin-converting enzyme inhibitor. Early discovery of renal artery stenosis may allow amelioration or cure of the hypertension and halt progressive loss of renal function. Although renal arteriography remains the gold-standard aid to diagnosis and to planning surgical intervention, it is an invasive procedure that may cause deterioration of renal function. In the presence of renal artery stenosis, glomerular filtration is maintained by angiotensin. Administration of captopril in renal scintigraphy removes this compensatory mechanism and causes a temporary impairment of renal function in the affected kidney. Nuclear tracers can visualize this impairment, thus allowing assessment of the physiologic significance of a renal artery stenosis. The test can be done as a outpatient procedure.
肾血管疾病是继发性高血压的常见病因。在有提示肾血管性高血压临床指标的患者中，高达三分之一存在肾动脉狭窄，这些指标包括药物治疗难以控制的高血压、年轻患者的重度高血压以及使用血管紧张素转换酶抑制剂后肾功能恶化。早期发现肾动脉狭窄可能使高血压得到改善或治愈，并阻止肾功能的进行性丧失。尽管肾动脉造影仍是诊断和规划手术干预的金标准辅助手段，但它是一种侵入性操作，可能导致肾功能恶化。在存在肾动脉狭窄的情况下，肾小球滤过由血管紧张素维持。在肾闪烁扫描中给予卡托普利可消除这种代偿机制，并导致患侧肾脏肾功能暂时受损。核示踪剂可显示这种损害，从而有助于评估肾动脉狭窄的生理意义。该检查可作为门诊程序进行。
