１１１,１１２,１１３,１１４．そしてこれらの腎機能の予備能の低下にはどういう指標がよいのかと考えてみると、そこで見てみますと、最近発表されたガイドラインから見てみますと、ここに「微量アルブミン尿あるいは腎機能低下」ということが入っております。
１１５,１１６．すなわち微量アルブミン尿で見てみますと、２型糖尿病ではこのように有名ですが、高血圧においても微量アルブミン尿を伴わない高血圧ではほとんど死亡が見られませんが、微量アルブミン尿を伴った高血圧では、少なくとも10年近くがたちますと、50％近くが心血管事故を起こすということが認められています。
１１７．さらにこのように微量アルブミン尿と冠動脈疾患の関係を見てみますと、高血圧で微量アルブミン尿がある場合には冠動脈疾患が非常に多いということがわかっています (33)。
１１８．以上のことをまとめさせていただきますと、若年者で特に初期の腎障害では厳重な血圧管理が必要。中等度の腎機能障害では朝の血圧の重要性、高齢者では収縮期血圧、さら高血圧患者での微量アルブミン尿を見ることが大切であり、また同様に心臓との関連も考慮することが重要であろうと考えます。
以上、本日の「腎と血圧調節」というレクチャーを終了させていただきます。
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