Powers D R, Wallin J D
Section of Nephrology, Louisiana State University School of Medicine, New Orleans 70112, USA.
Arch Intern Med. 1998 Apr 13;158(7):793-800. doi: 10.1001/archinte.158.7.793.
During the past few years, it has become apparent that there are factors that place a person at greater risk for the development and progression of renal failure. This has been documented since the early 1980s by the United States Renal Data System that has collected data confirming that end-stage renal disease occurs at a greater rate in certain subpopulations of Americans. It is evident from an examination of the data that African Americans and American Indians have an incidence of end-stage renal disease that is not proportional to their percentage of the total population. In fact, African Americans and American Indians are reported to have at least a 4-fold greater incidence of end-stage renal disease than white Americans. There have been 5 factors identified: hypertension, glucose intolerance, insulin resistance, salt sensitivity, and hyperlipidemia, which may play a greater role in these subpopulations. In addition, as with other populations, lifestyle issues may serve to alter these primary risk factors or may act as direct modulators of renal disease progression. There is also a possibility that interactions between risk factors frequently occur that may modify the development or progression of the disease. This article reviews these risk factors and emphasizes the interaction between hypertension and the other factors. In addition, the effects of antihypertensive agents on risk factors and on renal outcome are emphasized. Where possible, issues specific to African Americans and American Indians are underscored; however, one must accept that the database on these populations is only now developing. This review should help the clinician make appropriate choices when prescribing antihypertensive therapy for patients who may be at risk of developing progressive renal failure.
在过去几年中，已明显发现有些因素会使一个人面临肾衰竭发生和进展的更高风险。自20世纪80年代初以来，美国肾脏数据系统就记录了这一点，该系统收集的数据证实，终末期肾病在某些美国亚人群中的发生率更高。从数据检查中可以明显看出，非裔美国人和美国印第安人的终末期肾病发病率与其在总人口中的比例不相称。事实上，据报道，非裔美国人和美国印第安人的终末期肾病发病率至少是美国白人的4倍。已确定有5个因素：高血压、糖耐量异常、胰岛素抵抗、盐敏感性和高脂血症，这些因素可能在这些亚人群中起更大作用。此外，与其他人群一样，生活方式问题可能会改变这些主要危险因素，或者可能直接调节肾病进展。危险因素之间也经常发生相互作用，这可能会改变疾病的发生或进展。本文回顾了这些危险因素，并强调了高血压与其他因素之间的相互作用。此外，还强调了抗高血压药物对危险因素和肾脏结局的影响。在可能的情况下，强调了非裔美国人和美国印第安人特有的问题；然而，必须承认，关于这些人群的数据库目前才刚刚建立。这篇综述应有助于临床医生在为可能有进展性肾衰竭风险的患者开抗高血压治疗药物时做出合适的选择。
