Zucchelli P, Zuccalà A
Malpighi Department of Nephrology, Policlinico S. Orsola-Malpighi, Bologna, Italy.
J Nephrol. 1997 Jul-Aug;10(4):203-6.
Over the past decade the prevalence of end stage renal disease has risen progressively in industrialized societies. According to the data of renal disease Registries hypertensive nephrosclerosis appears to be a very important cause of progressive renal disease. However epidemiological data on the risk of hypertensive patients to develop renal failure offer contrasting results. In observational longitudinal studies a higher rate of decline in renal function is generally found in hypertensive compared to normotensive subjects. On the other hand, the inability of antihypertensive therapy to influence kidney destiny emerges from the large majority of interventional studies on mild-moderate hypertension in caucasian patients. At variance, the role of hypertension as etiologic factor seems to be sufficiently clear in African Americ: hypertension is more common, more severe and less easily to handle in a black patients. It is probable that the diagnosis of hypertensive nephrosclerosis is a confounding label laidon a heterogeneous group of diseases comprising a true hypertensive nephropathy (typical of black patients) along with occlusive or atheroembolic diseases common in aged caucasian patients. Our future efforts will have to be directed towards better identifying and properly classifying the various subgroup in order to optimize the treatment and prevent renal failure.
在过去十年中，终末期肾病的患病率在工业化社会中逐渐上升。根据肾病登记处的数据，高血压性肾硬化似乎是进行性肾病的一个非常重要的原因。然而，关于高血压患者发生肾衰竭风险的流行病学数据却给出了相互矛盾的结果。在观察性纵向研究中，与血压正常的受试者相比，高血压患者的肾功能下降率通常更高。另一方面，在大多数针对白种人轻度至中度高血压的干预性研究中，抗高血压治疗无法影响肾脏命运这一点显现出来。不同的是，高血压作为病因的作用在非裔美国人中似乎足够明确：高血压在黑人患者中更常见、更严重且更难控制。高血压性肾硬化的诊断很可能是一个混淆性标签，贴在了一组异质性疾病上，这些疾病包括真正的高血压肾病（典型的黑人患者）以及老年白种人患者中常见的闭塞性或动脉粥样硬化栓塞性疾病。我们未来的努力必须致力于更好地识别和正确分类各个亚组，以便优化治疗并预防肾衰竭。
