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Hypertensive nephropathy

2017-05-19 18:46

Hypertensive nephropathy

The incidence of hypertensive renal impairment was positively correlated with the severity and duration of hypertension. Other possible factors include sex, race, diabetes, hyperlipidemia and hyperuricemia, which affect each other and further aggravate kidney damage.

Often can be found in essential hypertension caused by other organs, mainly cardiovascular and cerebrovascular complications, these complications may occur earlier than the kidney damage, the condition is more serious, as the main prognostic factors or key factors. The most common complication of cardiac complications is hypertensive left ventricular hypertrophy, and is prone to heart failure, coronary heart disease, and angina pectoris;cerebrovascular complications for cerebral hemorrhage and cerebral infarction, cerebrovascular accident is the leading cause of death in primary hypertension in China. Essential hypertension can also cause retinal arteriosclerosis, further causing atherosclerotic retinopathy. The degree of retinal arteriosclerosis is proportional to blood pressure, which is more closely related to diastolic blood pressure. Retinal sclerosis is generally parallel to the degree of renal arteriosclerosis, can generally reflect the renal artery condition, so the fundus examination is very important.

Symptoms

More than 40 to 50 years of age, high blood pressure history of 5 to 10 years. Early only nocturia increased, followed by proteinuria, inpidual cases may be due to capillary rupture and transient ocular hematuria, but not with significant low back pain. Often associated with atherosclerotic retinopathy, left ventricular hypertrophy, coronary heart disease, heart failure, cerebral arteriosclerosis and / or cerebrovascular accident history. Slow progress of the course of progress, a small part gradually developed into renal failure, most renal dysfunction and severe conventional urine abnormalities. Malignant hypertension, diastolic blood pressure should be more than 16Kpa (120mmHg), accompanied by significant heart and brain complications and rapid development, a large number of proteinuria, often accompanied by hematuria, renal dysfunction.

Physical examination 

Hypertensive nephropathy

 Generalized blood pressure continued to increase (20.0 / 13Kpa, 150 / 100mmHg above); some eyelids and / or lower extremity edema, heart sector expansion; most arteriosclerotic retinopathy, when the eye has a stripe, flame-like bleeding and cotton Soft exudation, support for the diagnosis of malignant renal arteriosclerosis. Accompanied by hypertensive encephalopathy may have the corresponding signs of the nervous system.

Hypertensive nephropathy

(Red blood cells, white blood cells, transparent tube type) less, may have hematuria; early increase in serum uric acid, urine NAG enzyme (erythrocyte, white blood cells, transparent tube type), may have hematuria; , Β2-MG increased, urine concentration - dilution dysfunction; Ccr more slowly decreased, blood urea nitrogen, creatinine increased. Renal tubular damage more than glomerular damage.

(2) imaging examination of the kidney no change, the development of renal failure can occur in varying degrees of renal reduction; radionuclide early detection of renal damage; ECG often prompted left ventricular high voltage; chest X-ray or echocardiography often Suggesting that atherosclerosis, left ventricular hypertrophy or enlargement.

(C) difficult clinical diagnosis in the early renal biopsy should be.

Auxiliary check

(Erythrocyte, white blood cells, transparent tube type) less, may have hematuria; early blood uric acid increased urinary NAG enzyme, erythrocyte, Β2-MG increased, urine concentration - dilution dysfunction; Ccr more slowly decreased health search, blood urea nitrogen, creatinine increased. Renal tubular damage more than glomerular damage.

(2) imaging examination of the kidney no change, the development of renal failure can occur in varying degrees of renal reduction; radionuclide early detection of renal damage; ECG often prompted left ventricular high voltage; chest X-ray or echocardiography often Suggesting that atherosclerosis, left ventricular hypertrophy or enlargement

(C) difficult clinical diagnosis in the early renal biopsy should be.

Differential Diagnosis

Should be excluded from a variety of secondary hypertension, especially chronic nephritis hypertension. Malignant renal arteriosclerosis should be acute and progressive nephritis, systemic vasculitis and other disease phase identification.

Treatment of Hypertensive Nephropathy

First, early, mild hypertension and urine normal normal can be non-drug treatment, to maintain a good mood, weight loss limit salt, limited alcohol training Qigong and Taijiquan appropriate physical exercise.

Second, the choice of antihypertensive drugs: ① diuretics; ② β blockers; ③ calcium antagonists; ④ angiotensin converting enzyme inhibitors (ACEI). Among them, calcium antagonists, ACEI are more favorable for hemody

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