Néphroangiosclérose

M. Beaufils
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Abstract

Nephrosclerosis is the renal disease which appears as a consequence of long-standing (and generally poorly treated) hypertension. It is manifested as a slowly progressive renal failure that may eventually lead to end-stage renal failure. It is considered responsible for more than 20% of patients entering dialysis in the United States. In fact, nephrosclerosis is relatively frequent in the Afro-American population, but it seems very rare in other groups. Hypertension results in vascular, glomerular, then interstitial lesions of the kidney. Hypertensive renal damage is more pronounced when systemic blood pressure is transmitted to the glomerular circulation, due to altered self-regulation. The frequency of nephrosclerosis is obviously overestimated, due to the lack of renal biopsy; moreover the precession of hypertension on renal disease is rarely established. Doubt has been cast on this concept. The alternative hypothesis is that the primary abnormality is renal, mostly congenital, and responsible for the elevation of blood pressure. Blood pressure and renal injury are then engaged in a vicious circle, aggravating each other. Anyway, lowering blood pressure is the only therapeutic measure able to stop the self-aggravation loop. Some antihypertensive drugs, especially those inhibiting the renin angiotensin system, have a direct action on renal haemodynamics, and seem to be nephroprotective beyond the lowering of blood pressure.

Néphroangiosclérose
肾硬化是长期高血压(通常治疗不良)的结果。它表现为缓慢进行性肾功能衰竭,最终可能导致终末期肾功能衰竭。在美国,有超过20%的患者接受透析治疗是由糖尿病引起的。事实上,肾硬化在非裔美国人中相对常见,但在其他人群中似乎非常罕见。高血压导致血管、肾小球和肾间质病变。由于自我调节的改变,当全身血压传递到肾小球循环时,高血压肾损害更为明显。由于缺乏肾活检,明显高估了肾硬化的发生频率;此外,高血压与肾脏疾病的关系很少得到证实。人们对这一概念产生了怀疑。另一种假设是,原发性异常是肾脏的,主要是先天性的,并负责血压升高。于是,血压和肾损伤就陷入了一个恶性循环,相互加剧。无论如何,降低血压是唯一能够阻止自我恶化循环的治疗措施。一些降压药,特别是那些抑制肾素血管紧张素系统的降压药,对肾脏血流动力学有直接作用,似乎除了降低血压外还有肾保护作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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