臨牀透析 Vol.24 No.9(2-4)


特集名 慢性腎不全病態に対する新たな視点 -- 治療目標をどこにおくか ?
題名 [病態]アルドステロン -- 腎不全における新たな内分泌危険因子
発刊年月 2008年 08月
著者 長瀬 美樹 東京大学大学院医学系研究科腎臓・内分泌内科/東京大学大学院22世紀医療センター臨床分子疫学講座
【 要旨 】 末期腎不全患者では,腎障害の程度と相関した高アルドステロン血症が認められることが多い.その原因として,レニン刺激,高カリウム血症,エリスロポエチン,別のファクターの関与が示唆されている.近年,アルドステロンが心・腎・血管などの細胞に直接作用して炎症・線維化反応を促進し,臓器障害の進展に深く関与することが注目されている.慢性腎臓病患者は末期腎不全 (腎死) よりもはるかに高率に心血管病で死亡することに留意すべきである.慢性透析患者において,血中アルドステロン濃度と左心室肥大に関連が認められている.これらに因果関係が存在するのであれば,抗アルドステロン薬投与により左心室肥大,ひいては生命予後が改善することが期待される.
Theme New Insights into Uremic Conditions and Their Therapeutic Targets
Title Endocrine disturbance : aldosterone as novel endocrine risk factor for chronic renal failure
Author Miki Nagase Department of Nephrology and Endocrinology, and Department of Clinical and Molecular Epidemiology, University of Tokyo Graduate School of Medicine / 22nd Century Medical and Research Center, University of Tokyo Graduate School of Medicine
[ Summary ] Patients with end-stage renal disease often have elevated plasma aldosterone concentrations, which appear to correlate with the degree of renal dysfunction. The factors contributing to hyperaldosteronemia may be renin stimulus, hyperkalemia, erythropoietin treatment, and / or other factors including adipocyte-derived aldosterone releasing factor(s). Aldosterone is traditionally viewed as a hormone regulating electrolytes, volume, and blood pressure homeostasis by acting on the distal nephrons in the kidneys. Recently, a growing body of evidence has suggested that aldosterone also plays a pathogenetic role in cardiovascular and renal injury. Aldosterone has been shown to act on nonepithelial cells in the heart, vasculature, and kidneys to cause tissue remodeling, fibrosis, and endothelial dysfunction. Accumulating lines of evidence indicate that cardiovascular disease is the main cause of death in patients on long-term dialysis. Clinical studies have reported a correlation between left ventricular hypertrophy and plasma aldosterone concentrations in nondiabetic patients with end-stage renal failure treated with hemodialysis. If there exists a cause-effect relationship between hyperaldosteronism in chronic renal failure and cardiac hypertrophy, it is expected that aldosterone blockers may reduce left ventricular hypertrophy, leading to improved life expectancy in patients on hemodialysis.
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