Malignant hypertensive arteriosclerosis
Introduction
Introduction to malignant hypertensive small arteriosclerosis Malignant hypertensive small arteriosclerosis is mainly characterized by renal artery necrosis, proliferative endarteritis and glomerular fibrin-like necrosis. Glomerulonephritis, chronic renal failure, renal artery stenosis, renal vasculitis and rare endocrine disease (pheochromocytoma, primary aldosteronism) secondary hypertension is the formation of malignant hypertensive small arterial The main cause of kidney hardening. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: high blood pressure
Cause
Causes of malignant hypertensive small arteriosclerosis
Pathological factors (45%):
Pathological changes, including changes in kidney size, may depend on the length of the clinical course and the presence of the original disease. The necrosis of the cellulose in the aorta and the spread to the glomerulus are characteristic of malignant small arteriosclerosis. Interlobular arteries and small arterioles are characterized by proliferative endarteritis and thickening of the intima due to fine concentric stratification of collagen, which often causes the lumen of the vessel to disappear. This stratification is typical. Onion skin-like appearance, this damage may not be distinguishable from the damage of thrombotic thrombocytopenic purpura-hemolytic-uremic syndrome and scleroderma.
Disease factors (45%):
For mild to moderate hypertension, the initial response is arterial and arteriolar vasoconstriction to maintain a relatively constant level of normal tissue perfusion. As the severity of hypertension increases, self-regulation eventually fails, and elevated blood pressure will damage the arterioles. And the capillary wall, the lack of self-regulation of the brain can lead to clinical manifestations of cerebral edema and hypertensive encephalopathy.
Prevention
Malignant hypertensive small arteriosclerosis prevention
1. Exercise: Strengthen physical exercise, increase the body's resistance, pay attention to the combination of work and rest, daily walks can be adhered to, self-not feeling fatigue, but also Qigong exercise, Tai Chi, do aerobics, to enhance physical fitness, Improve the body's resistance, prevent colds, and prevent the disease from aggravating due to respiratory infections.
2. Keep urinary patency: The urination is smooth, indicating that the excretion function of the kidney is normal. If the urethral obstruction occurs, the urinary tract will not be smooth, it will increase the chance of inflammation of the renal pelvis and renal parenchyma, increase the burden on the kidney, and even cause urinary poisoning. Common urination is not smooth. Causes include urinary tract stones, enlarged prostate, tumors, and tuberculosis.
3. Pay attention to diet: pay attention to eating light and easy to digest food, avoid contraindications, let patients understand the importance and necessity of correct diet, avoid eating hard and cold food, overeating, over-eating fat, protect kidneys need to eat Protein and sugar, should not eat too high fat diet, too much fat in the diet, prone to renal arteriosclerosis, kidney atrophy, causing arteriosclerotic kidney disease, alkaline food is beneficial to the kidneys, can prevent urinary calculi Also, you can eat some winter melon, white thorn root, red bean, mung bean, etc., which is good for diuretic heat and protecting the kidneys.
4. Symptomatic care.
5. Leisure and work: Try to participate in social activities as little as possible. Once the patient is diagnosed with kidney disease, at the beginning stage, the rest should be based on active treatment and observation of changes in the condition. If the condition improves, the edema subsides and the blood pressure returns to normal or near normal. Urine protein, red blood cells and various tube types are small, and the kidney function is stable. After 3 months, you can start light work, avoid strong physical labor, and prevent respiratory and urinary tract infections.
Complication
Complications of malignant hypertensive small arteriosclerosis Complications
Often the nervous system, cardiovascular system, blood system and other complications caused by elevated blood pressure, more serious is accompanied by severe hypertension and rapid renal failure.
Symptom
Malignant hypertensive small arteriosclerosis symptoms common symptoms renal involvement fundus hemorrhage and hemorrhage hematuria with proteinuria hypertension heart enlargement
Symptoms of malignant hypertensive small arteriosclerosis:
Hypertension, kidney involvement, hematuria, hematuria with proteinuria, fundus hemorrhage and exudation, enlarged heart.
The diagnosis is based on the presence of persistent diastolic blood pressure >120 mmHg, neuroretinopathy and other cardiac and renal involvement.
Kidney involvement. Allergic purpura, also known as hemorrhagic capillary venom, is a capillary allergic hemorrhagic disease associated with autoimmune damage to blood vessels. Clinically, the renal involvement caused by allergic purpura is called allergic purpura nephritis. Clinical features In addition to purpura, there are often rashes and angioedema, arthritis, abdominal pain and nephritis.
Examine
Examination of malignant hypertensive small arteriosclerosis
Urine check
Includes proteinuria (sometimes within the range of kidney disease) and microscopic hematuria.
2. Physical examination
Neuroretinopathy (bleeding, exudation, and often papilledema) is present, with enlarged heart and evidence of ventricular hypertrophy.
3. Hematology examination
Abnormal blood (microvascular hemolytic anemia, disseminated intravascular coagulation) is common, and very high levels of renin and aldosterone are typical.
Diagnosis
Diagnosis and diagnosis of malignant hypertensive small arteriosclerosis
diagnosis
According to the cause, clinical manifestations and related examinations can be diagnosed.
Differential diagnosis
Should exclude all kinds of secondary hypertension, especially chronic nephritis, hypertensive malignant renal arteriosclerosis should be differentiated from acute nephritis systemic vasculitis.
1. Chronic glomerulonephritis (chronic glomerulonephritis) refers to different pathological types of bilateral glomerular diffuse or focal inflammatory changes caused by various causes, clinical onset occult, long course of disease, slow development of the disease The general term for primary glomerular disease, so strictly speaking it is not an independent disease.
2. Arteriosclerosis is a non-inflammatory disease of the arteries. It is a general term for degenerative and proliferative lesions of arterial wall thickening, hardening, loss of elasticity and narrow lumen. Common atherosclerosis, arteries Middle calcification, small arteriosclerosis 3 kinds.
