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肾素—血管紧张素—醛固酮系统是肾血管病变引起高血压的主要激素系统。口服血管紧张素转换酶抑制剂(ACEI)的出现,提供了对肾血管性高血压(RH)进行特异治疗的可能。但近六年来,越来越多的文献报道RH患者应用ACEI治疗过程中肾功能迅速下降。血管紧张素既是一种全身性激素,又是一种肾内局部性激素,肾素—血管紧张素系统的各种成分均可在肾内发现,其肾内作用是复杂的。血管紧张素可影响肾血管张力,从而改变肾血流量及肾内血流分布;可作用于肾小球和小球动脉,从而影响滤过分数(Kf)和小球动力学;它对肾小管的作用包括钠的重吸收,它对逆流倍增的维持是重要的,由此可影响尿的浓缩及尿素排泄。因此ACEI通过肾素—血管紧张素系统而明显影响肾功能是毫不奇怪的。
The renin-angiotensin-aldosterone system is the major hormonal system that causes hypertension in renovascular lesions. The emergence of oral angiotensin-converting enzyme inhibitor (ACEI) provides the possibility of specific treatment of renovascular hypertension (RH). However, in the recent six years, more and more literatures report that the renal function in patients with RH is rapidly decreased during the course of ACEI treatment. Angiotensin is both a systemic hormone and a local intrarenal hormone. Various components of the renin-angiotensin system can be found in the kidney and its intrarenal effects are complex. Angiotensin can affect renal vascular tone, thereby changing the renal blood flow and renal blood flow distribution; can act on the glomerular and small ball arteries, thus affecting the filtration fraction (Kf) and the ball dynamics; it tubular The role of sodium includes reabsorption of sodium, which is important for the maintenance of countercurrent doubling, which can affect urine concentration and urea excretion. It is therefore not surprising that ACEI significantly affects renal function through the renin-angiotensin system.