Hypertensive nephropathy
Introduction
Introduction to Hypertensive Nephropathy It is a benign small arteriosclerosis (also known as hypertensive renal arteriosclerosis) and malignant small arteriosclerosis caused by essential hypertension, accompanied by a corresponding clinical manifestation of the disease. The age is more than 40 to 50 years old, the history of hypertension is more than 5 to 10 years. In the early stage, only nocturia is increased, followed by proteinuria. In some cases, transient gross hematuria may occur due to capillary rupture, but no obvious low back pain. , often associated with arteriosclerotic retinopathy, left ventricular hypertrophy, coronary heart disease, heart failure, cerebral arteriosclerosis and / or cerebrovascular accident history. basic knowledge The proportion of illness: 0.12% Susceptible population: The age is more than 40 to 50 years old, and the history of hypertension is 5 to 10 years. Mode of infection: non-infectious Complications: stroke, heart disease
Cause
Causes of hypertensive nephropathy
1. Weight and obesity factors: Weight gain is not only a factor that causes obesity, but also a risk factor for high blood pressure. The fatter the body, the greater the risk of developing hypertension.
2, high-salt dietary factors: an important reason why people in northern China have more hypertension than southerners is that the taste of the northerners is salty, and the amount of salt taken per day is higher.
3. Drinking factors: The weather in the north is cold, and there are more people drinking hot liquor than in the south. The risk factors for hypertension also increase.
4, mental and psychological factors: work stress, heavy mental burden, irregular life, long-term stay up all night, lack of sleep or rest, can cause high blood pressure
5, the body's calcium deficiency is also one of the main causes of hypertension.
6. Genetic factors: Domestic and foreign data studies have shown that hypertension has a strong genetic predisposition, but genetic factors can only lead to an increase in blood pressure if it interacts with environmental factors.
7, weather factors: due to the weather is cold, skin and subcutaneous tissue blood vessels contract, resulting in increased peripheral vascular resistance, resulting in elevated blood pressure.
Prevention
Hypertension and kidney disease prevention
Early prevention of hypertensive nephropathy is very important, and the common preventive measures are as follows:
First, the age is 40-50 years old, the history of hypertension is more than 5-10 years, if it is determined that the increase of microalbumin, it should be highly vigilant.
Second, nocturia increased, proteinuria or transient hematuria, often check renal function, urine protein qualitative, 24-hour urine protein quantification, pay attention to blood pressure, do fundus examination.
Third, keep the stool smooth.
Fourth, avoid contact with heavy metals, toxic substances and drugs that may damage the kidneys.
Complication
Hypertensive nephropathy Complications, stroke, heart disease
It is easy to have complications such as stroke, heart disease and other cardiovascular diseases.
Symptom
Hypertensive nephropathy symptoms Common symptoms Urine routine abnormal proteinuria nocturia increased hypertension Renal failure Heart failure Sclerosing blood pressure High hematuria Left ventricular hypertrophy
First, medical history and symptoms
The age is more than 40 to 50 years old, the history of hypertension is more than 5 to 10 years, only the nocturia is increased in the early stage, followed by proteinuria. In some cases, transient gross hematuria may occur due to capillary rupture, but no obvious low back pain. , often with arteriosclerotic retinopathy, left ventricular hypertrophy, coronary heart disease, heart failure, cerebral arteriosclerosis and / or cerebrovascular accident history, slow progression, a small part of the progressive development of renal failure, most of the kidney function is often young Damage and abnormal urine routine, diastolic hypertension need to exceed 14Kpa (120mmHg), with obvious heart and brain complications and rapid development, a large number of proteinuria, often accompanied by hematuria, progressive renal function decline.
Second, physical examination found
Generally, the blood pressure is continuously increased (20.0/13Kpa, 150/100mmHg or more); some eyelids and/or lower extremity edema, enlarged heart, etc.; most arteriosclerotic retinopathy, when the fundus has streaks, flaming hemorrhage and cotton-like Soft exudation supports the diagnosis of malignant renal arteriosclerosis, and those with hypertensive encephalopathy may have corresponding signs of nervous system localization.
Third, auxiliary inspection
(A) mostly mild to moderate proteinuria, more than 1.5 ~ 2.0g in 24 hours; microscopic examination of formation (red blood cells, white blood cells, transparent cast) less, may have hematuria; early blood uric acid increased, urine NAG enzyme , 2-MG increased, urine concentration-dilution dysfunction; Ccr decreased slowly, blood urea nitrogen, creatinine increased, renal tubular dysfunction more than glomerular dysfunction.
(B) imaging examination of the kidneys, there is no change, the development of kidney failure can occur in different degrees of kidney reduction; renal function damage occurs early in the radionuclide examination; ECG often prompts left ventricular high voltage; chest X-ray or echocardiography often Prompt aortic sclerosis, left ventricular hypertrophy or enlargement.
(3) Patients with clinical diagnosis should be diagnosed with kidney biopsy at an early stage.
Examine
Hypertensive nephropathy check
(A) mostly mild to moderate proteinuria, more than 1.5 ~ 2.0g in 24 hours; microscopic examination of formation (red blood cells, white blood cells, transparent cast) less, may have hematuria; early blood uric acid increased, urine NAG enzyme , 2-MG increased, urine concentration-dilution dysfunction; Ccr decreased slowly, blood urea nitrogen, creatinine increased, renal tubular dysfunction more than glomerular dysfunction.
(B) imaging examination of the kidneys, there is no change, the development of kidney failure can occur in different degrees of kidney reduction; renal function damage occurs early in the radionuclide examination; ECG often prompts left ventricular high voltage; chest X-ray or echocardiography often Prompt aortic sclerosis, left ventricular hypertrophy or enlargement.
(3) Patients with clinical diagnosis should be diagnosed with kidney biopsy at an early stage.
Diagnosis
Diagnosis and diagnosis of hypertensive nephropathy
diagnosis
First, medical history and symptoms
The age is more than 40 to 50 years old, and the history of hypertension is 5 to 10 years. In the early stage, only nocturia increased, followed by proteinuria. In some cases, transient gross hematuria occurred due to capillary rupture, but no obvious low back pain. Often associated with arteriosclerotic retinopathy, left ventricular hypertrophy, coronary heart disease, heart failure, cerebral arteriosclerosis and/or cerebrovascular accident history. The course of the disease progressed slowly, and a small part of it gradually developed into renal failure. Most of the renal function was often young and the urine was abnormal. The diastolic blood pressure of patients with malignant hypertension needs to exceed 16Kpa (120mmHg), accompanied by obvious heart and brain complications and rapid development, a large number of proteinuria, often accompanied by hematuria, progressive renal function decline.
Second, physical examination found
Generally, the blood pressure is continuously increased (20.0/13Kpa, 150/100mmHg or more); some eyelids and/or lower extremity edema, enlarged heart, etc.; most arteriosclerotic retinopathy, when the fundus has streaks, flaming hemorrhage and cotton-like Soft exudation supports the diagnosis of malignant renal arteriosclerosis. Patients with hypertensive encephalopathy may have corresponding signs of nervous system localization.
Differential diagnosis
Should exclude all kinds of secondary hypertension, especially chronic nephritis hypertension, malignant renal arteriosclerosis should be differentiated from acute nephritis, systemic vasculitis and other diseases.
