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动脉粥样硬化性双侧肾动脉狭窄或孤立有功能肾肾动脉狭窄的治疗

Author
Stephen Textor, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc
Translators
刘刚, 主任医师，教授

引言

肾动脉狭窄是较高龄高血压患者中相对常见的表现。然而，仅在某些情况下肾动脉狭窄是导致高血压(即肾血管性高血压)的原发原因。

在大多数肾动脉狭窄病例中，一侧肾受累同时另一侧基本正常，因此被定义为“单侧”疾病。而双侧肾动脉或功能性孤立肾动脉高度狭窄的个体，会因此影响全部功能性肾组织，被认为有“双侧”疾病。双侧肾动脉狭窄或功能性孤立肾动脉狭窄值得具体考虑，因为其对促发液体潴留、肾功能丧失和充血性心力衰竭有额外促成作用。

双侧动脉粥样硬化性肾动脉狭窄(或功能性孤立肾肾动脉狭窄)的治疗将总结在此。肾血管性高血压及确立肾动脉狭窄诊断的临床特征、单侧动脉粥样硬化性肾动脉狭窄的治疗、动脉粥样硬化性肾血管疾病有关的慢性肾脏病相关问题、和纤维肌性疾病的诊断和治疗详细参见别处。(参见“哪些患者应评估肾血管性或其他原因的继发性高血压？”和“诊断肾血管性高血压”和“单侧动脉粥样硬化性肾动脉狭窄的治疗”和“动脉粥样硬化性肾动脉狭窄引起的慢性肾脏病的临床表现及诊断”和“纤维肌性发育不良的临床表现和诊断”和“肾动脉纤维肌性发育不良的治疗”)

表现和诊断概述

流行病学 — 在轻度高血压患者中肾血管性高血压患病率可能小于1%，但在急性(即使是在原有的血压升高的基础上)、重度或难治性高血压患者中其患病率可高达10%-40%[1]。(参见“哪些患者应评估肾血管性或其他原因的继发性高血压？”，关于‘肾血管性高血压的临床特征’一节)

在2项纳入肾动脉狭窄患者的前瞻性治疗试验中，双侧患病(而不是单侧疾病)的患病率范围为20%-46%[2,3]。

                

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Literature review current through: 2017-06 . | This topic last updated: 2015-09-01.
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