高血压合并动脉粥样硬化性肾动脉狭窄的诊治进展

Diagnosis and treatment of hypertension with atherosclerotic renal arterial stenosis

高血压伴动脉粥样硬化性肾动脉狭窄是引起老年患者终末期肾脏病的主要原因，尤其是65岁以上糖尿病合并外周血管病的患者。当临床出现急进性高血压、顽固性高血压、恶性高血压及无法解释的肾脏萎缩、难治性肺水肿时高度提示肾动脉狭窄的可能。彩色多普勒超声、磁共振血管成像、螺旋CT血管造影和肾动脉造影是主要的检查方法。除药物治疗外，也可采取介入和外科手术治疗，但要严格掌握适应证，预防并发症。

Hypertension accompanied with atherosclerotic renal arterial stenosis is a relatively common condition which leads to end stage renal failure in elderly patients, especially for those more than 65 years old with diabetics and peripheral vascular diseases. Clinical manifestations, such as accelerated hypertension, resistant hypertension, malignant hypertension, unexplained renal atrophy, and refractory pulmonary edema, strongly suggest the possibility of renal artery stenosis. Color Doppler ultrasonography, magnetic resonance angiography, spiral CT angiography and renal angiography are main examination measures. Besides medication, intervention and operation are also effective, although strict indication criteria must be followed to prevent complications.