蒋雄京教授-肾血管病的处理.docx

Management of Renovascular Hypertension 阜外心血管病医院心内科蒋雄京 Interrelation among Renal Artery Stenosis,Hypertension, and Chronic Renal Failure Definition of Renal Artery Stenosis Renal artery stenosis (RAS) is defined as narrowing of the lumen of the renal artery. *angiographic diameter stenosis50% *translesional pressure gradient of 20 mm Hg peak systolic or 10 mm Hg mean The most common causes of RAS are atherosclerosis (80%)， aortoarteritis(15%), and fibromuscular dysplasia(5%) in China Angiographic Appearance of the Three Common s of Renal Artery Stenosis Prevalence 1~3% in hypertensive population 20?30% in patients with secondary hypertension Incidence of Renal Artery Stenosisat Cardiac Catheterization AuthorsYearCrowley Conlon Weber Yamashita Rihal1998 2000 2002 2002 2002Country USA Ireland Austria Japan USAPatients 14152 3987 177289297Buller AddadCanadaTunisia837Age61526366656 Authors Year Crowley Conlon Weber Yamashita Rihal 1998 2000 2002 2002 2002 Country USA Ireland Austria Japan USA Patients 14152 3987 177 289 297 Buller Addad Canada Tunisia 837 Age 61 52 63 66 65 67 CAD (%) HT (%) RAS (%) 891 006276N68100 72 67 35 11 CAD = Coronary artery disease; HTN = Hypertension; RAS = significant renal artery stenosis; NA = nonavallable. Incidence of Renal Artery Stenosis at Cardiac Catheterizationin Chinese population Zhang et al 1200 9.7 1.7 Suspected CHD Wang et al 230 14.8 NR CHD Shen et al 280 153 5.0 Suspected CHD Liu et al 141 184 NR Suspected CHD Mean 1851 1L8 NR Study Authors Pts, n RAS50% Bilateral, % Indication Angiatensinogen r血 y Decrease of rena I blood flow A四派切I \ 15岐 Angiotensin II ?,,?A Vasoconstriction —Hypertension Aldosterone .?■.A Waterretenlion Lafvrnnai^rinryCcrticoI thiinc^lrxi ?inrt ibM of r己 Lafvrnnai^rinry CcrticoI thiinc^lrxi ?inrt ibM of r己rwn Con Im I vhiinininaHriri rfif rerwi F4HH Progressive Atherosclerosis, Renal Artery Stenosis, and Ischemic Nephropathy LiarRy Oi Mile I Mrrr.w^l Lelt RnpHltUIUllai ierv Aorta lot a i ginrr