Brenner B M, Mackenzie H S
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Kidney Int Suppl. 1997 Dec;63:S124-7.
Partial ablation of renal mass initiates a cycle of progressive glomerular injury in the remnant. This process is associated with glomerular hypertrophy, hyperfiltration and systemic hypertension. Congenital deficits in nephron number are also associated with adverse effects on the kidney. Since intrauterine growth retardation is associated with formation of fewer nephrons, the recent observation that low birth weight is associated with increased risk of hypertension in later life raises the possibility that even modest reductions in nephron complement may also predispose to renal injury. Likewise, the numbers of viable nephrons supplied to renal, allograft recipients may be critical determinants of late allograft success or failure, since subsequent acute ischemia and rejection combine to lower the nephron complement to levels akin to the more extensive reductions in renal mass seen in patients with surgical reduction of a solitary kidney, in whom predisposition to hypertension and glomerulosclerosis is evident. This article summarizes recent findings suggesting that congenital nephron endowment is a significant factor in the pathogenesis of chronic renal disease and hypertension.
肾部分切除术会引发残余肾单位进行性肾小球损伤的循环。这一过程与肾小球肥大、超滤和系统性高血压相关。肾单位数量的先天性缺陷也会对肾脏产生不良影响。由于宫内生长迟缓与肾单位形成减少有关，最近的观察发现低出生体重与日后患高血压风险增加相关，这增加了即使肾单位数量适度减少也可能易患肾损伤的可能性。同样，移植给肾移植受者的存活肾单位数量可能是肾移植后期成败的关键决定因素，因为随后的急性缺血和排斥反应共同作用，使肾单位数量降至类似于接受单肾手术切除患者中更广泛肾实质减少的水平，这些患者明显易患高血压和肾小球硬化。本文总结了最近的研究结果，表明先天性肾单位禀赋是慢性肾病和高血压发病机制中的一个重要因素。
