肾动脉狭窄的诊断和治疗的中国专家共识Chinese expert consensus on theWord格式文档下载.docx

肾动脉狭窄的诊断和治疗的中国专家共识Chinese expert consensus on theWord格式文档下载.docx

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1.Preface

Renalarterystenosis（RAS）isoneofthemostcommoncausesofsecondaryhypertension.Takayasuarteritis,atherosclerosis,andmusclefiberdysplasiaarethecommoncausesofRAS.Priorto1990s,Takayasuarteritiswastheleadingcauseofrenalarterystenosisinchina.Butoverthepasttenyears,atheroscleroticRAShasreplacedTakayasuarteritisastheleadingcauseofRAS.Inrecentyears,theincidenceofatheroscleroticdiseaseinChinahasbeenincreasing.

2.epidemiology

Thetotaldiagnosticvalueof65yearsofageorolderinthecrowdRASrateisabout6.8%,higherinmalethaninfemale.RAShasahigherincidenceinhigh-riskgroups（suchascoronaryheartdiseasepatientsandperipheralarterialdiseasepatients）.Acceptrenalarteryangiographyfoundthatsignificantrenalarterystenosisinundergoingcardiaccatheterization（morethan50%）andtheincidencerateisabout11%~18%.

Atheroscleroticrenalarterystenosisisaprogressivedisease.Renalarteryocclusionismorecommoninpatientswithseverestenosisandthosewithdiabetesorseverehypertension.

Consequencesof3.RAS

（1）renovascularhypertension

Renovascularhypertensionisthesecondleadingcauseofsecondaryhypertension.AlthoughhypertensionisamajorclinicalmanifestationofRAS,theextentofanatomicrenalarterystenosisisnotlinearlyrelatedtohypertension.

（2）end-stagerenaldisease（ESRD）;

Atotalof683patientswithESRDundergoingdialysisattheendofthelast20yearswerestudied,ofwhom83（12%）werediagnosedwithRAScausedbyESRD.However,accordingtothecurrentdata,wecannotfullydefinetheimpactofRASonESRD.ThereisnodatatoshowhowmanyRASpatientseventuallyneeddialysisbecauseofRAS.

（3）renalatrophy;

AtrophyofthekidneyisadirectconsequenceofRASandisassociatedwiththeseverityandprogressionofthedisease.Thepatientwithprogressiverenalfailureisclinicallyprogressive.TheclinicalprognosisofpatientswithadvancedRASispoor（e.g.,renalfailure,reducedrenalvolume,andreducedsurvival）

（4）recurrentpulmonaryedema

PatientswithRASmaydeveloprecurrentorrecurrentpulmonaryedema.PatientswithseverebilateralorunilateralRASwithhemodynamicsignificancemayexhibitcapacityoverload.PatientswithunilateralRASmayalsoexperienceincreasedpulmonaryedemaduetoanincreaseinleftventricularafterloadduetoangiotensinmediatedvasoconstriction.

（5）theriskofcardiovasculareventsincreases

ThehighriskofcardiovasculareventsinpatientswithRASmaybeduetoagreaterburdenofsystemicatherosclerosis.InpatientswithsevereRAS,coronaryarteryischemiaisinducedbyhigherlevelsofangiotensinII,whichcausevasoconstrictionofthesurroundingarteries.

（6）asymptomaticRAS

AsymptomaticasymptomaticRASisalsoaclinicalmanifestationofRASinpatientsundergoingcoronaryangiographyandperipheralangiography,andasymptomaticRAS.ComparedwithpeoplewithoutRAS,theprognosisofasymptomaticRASpatientsispoor,andtheprognosisisrelatedtothedegreeofRAS.AstudyfoundthattheaccidentaldiscoveryofcardiaccatheterizationinasymptomaticandsevereRAS（morethan75%）ofthe4yearsurvivalratewas57%,and89%patientswithsevereRAS.

Thereisnoresearchprospective,randomizedcontrolledcomparisongoodtoevaluatetherapyinpatientswithsymptomsofrenalarterydisease（orrelateddrugs）therelativerisksandbenefits,sotheeffectoftheseinterventionsremainscontroversial.

4.indicatetheclinicalconditionofRAS

ThefollowingsituationsmayindicateaRAS

（1）thefollowingkindsofhypertension:

A）hypertensionbeforeage30orseverehypertensionafter55yearsofage;

Malignanthypertension（b）ofsuddenworseninghypertensioncancontrolthepast）;

（c）resistanthypertension（whichisstilldifficulttoachievewhentargetbloodpressureisusedwhencombinedwithadequateamountsof3antihypertensivedrugs,includingdiuretics）;

（d）associatedwithmalignanthypertensionincludingacuterenalfailure,acutedecompensatedcongestiveheartfailureornewonsetofopticnerveorotherbrainlesionsandIII~IVretinopathyandacutehypertensiontargetorgandamage）.

（2）whentheuseofACEIorARBdrugsoccurs,theonsetofnewonsetofhypoxemiaordeteriorationofrenalfunction（elevatedserumcreatinineisgreaterthan50%）

（3）thereisunexplainedrenalatrophyorbilateralkidneysizedifferencegreaterthan1.5cm

（4）suddenunexplainedpulmonaryedema

5.diagnostictools

Recommendtheuseofduplexultrasound,computedtomographyangiography（CTA）,magneticresonanceangiography（MRA）diagnosisofthree