International Circulation: Are we more interested in preventing kidney damage than preserving kidney function?
《国际循环》：我们是否对预防肾脏损伤较保留肾脏功能更感兴趣？
　Dr. Textor: We would like to restore blood flow before there is irreversible loss of kidney function and while there is still enough kidney function to avoid complications with heart failure or symptomatic kidney failure. Many people can tolerate a small drop in kidney function and never notice it. If that were stable， then there is no need to make put forward the expense of hazard of this procedure.
Dr. Textor：必须将这个问题放在人的背景下。如果他们丧失肾功能或者有在其有生之年丧失肾功能的风险，那么你不得不重视这个个体。如果在他们还有五年的预期寿命，你最好尽量避免肾功能衰竭的进展，因为70岁时透析是不愉快的。另一方面，如果他们有很多问题，且病情并未快速进展，你必须要问，是否有净收益。这是一个接一个的临床判断。我们的确利用工具。我们在我们医院使用阻力指数和功能性MR以观察是否存在真正的肾脏缺氧。如果不是缺氧肾脏，且代偿良好，那么很难解释会从治疗中获益。坦率地说，它是一个接一个决定，它不适合大规模的临床试验。其他不言而喻的要素是人群平均值掩盖了完全不同的结果。有一组患者恢复了肾功能并改善，有相当数量将会是稳定的，但总是有一组会变得更糟。整组的平均值将几乎不变。有25％的人将恢复肾功能，你会不愿意漏掉这一部分。很难确切的规定标准。
　International Circulation: When it comes to start treating for kidney disease， what would be the measure you go by?
《国际循环》：当谈到开始治疗肾脏疾病时，您将会遵循什么措施？
　Dr. Textor: You have to put this in the context of the person. If they are losing kidney function or at risk of losing kidney function within their life time， you have to sit down with individual. If they have five years ahead of them， you better try to avoid moving forward with kidney failure， because life on dialysis at age 70 is not pleasant. On the other hand， if they have so many problems and things are not moving quickly， you have to ask if there is a net gain. These are one-by-one clinical judgments. We do use tools. We use the resistive index and functional MR in our institution to see whether or not there is true hypoxia in the kidney. If it is not a hypoxic kidney and it is well compensated， it is hard to make a case to gain from treatment. To be frank， it is a one-by-one decision and it is not suited to large trials. The other unspoken element is that average population values conceal radically different outcomes. There is a group of patients that recover kidney function and improve， there is a fair number that will stabilize， but there is always a group that will get worse. The average values for a group will be almost unchanged. There are 25% of the people that will recover kidney function that you would hate to miss. It is hard to exactly state criteria.
　Dr. Textor：必须将这个问题放在人的背景下，如果他们丧失肾功能或者有在其有生之年丧失肾功能的风险，那么你就不得不重视这个个体。如果他们还有五年的预期寿命，你最好尽量避免他们肾功能衰竭的进展，因为70岁时透析是很不好的。另一方面，如果他们有很多问题，且病情并未快速进展，你必须要问，是否有净收益，这是一个接一个的临床判断。我们的确利用工具，比如在我们医院，我们使用阻力指数和功能性MR以观察是否存在真正的肾脏缺氧。如果不是缺氧肾脏，且代偿良好，那么很难解释会从治疗中获益。坦率地说，这样一个接一个决定，不适合大规模的临床试验。其他不言而喻的要素是人群平均值掩盖了完全不同的结果。有一组患者恢复了肾功能并得到改善，且有相当数量将会是稳定的，但总是有一组会变得更糟。整组的平均值将几乎不变。比如有25％的人将恢复肾功能，你会不愿意漏掉这一部分？所以很难确切的规定标准。

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