Urea clearance disorder
Introduction
Introduction Long-term increase in blood pressure leads to hardening of the small arteries of the kidney, which gradually affects kidney function. In the early stage of hypertension, there is only renal arteriolar spasm, but there is no obvious urinary system symptoms in the clinic. In the later stage, hypertension can promote vitreous degeneration or glomerular atherosclerosis in the renal arterioles. According to biopsy results, renal arteriosclerosis accounted for 82.4% of hypertensive patients with a course of more than 4 months. When kidney function declines, symptoms such as polyuria and nocturia may occur, indicating that the kidney concentration function is lowered. If the renal function is further reduced, there may be oliguria, hematuria (mostly under the microscope hematuria), proteinuria, tubular urine, phenol red excretion and urea clearance disorders, nitrogen retention, etc., and finally uremia can occur. Hypertension died of uremia in patients with 1.5% to 5%.
Cause
Cause
The cause of hypertension is unknown, and the factors related to the disease are:
Age: The incidence rate increases with age.
Salt: The incidence of hypertension is high in people who eat more salt.
Weight: The incidence of obesity is high.
Genetics: About half of hypertensive patients have a family history.
Environment and occupation: a noisy working environment. Excessive stress in mental work is prone to high blood pressure. The incidence of high pressure in cities is higher than in rural areas.
Examine
an examination
Related inspection
Blood urea nitrogen (BUN) urea nitrogen urea clearance rate (UCL)
According to the onset of illness and the progression of the disease, it can be divided into a slow-moving type and a rapid-entry type.
First, slow-moving hypertension.
(1) Early manifestations: early asymptomatic, occasionally found blood pressure increased during physical examination, or feeling dizziness, headache, vertigo, tinnitus, insomnia, fatigue, inattention, etc. after mental stress, emotional or tiredness, may be Advanced mental dysfunction. Early blood pressure only temporarily increased, and blood pressure continued to increase with the progress of the disease, and organs were involved.
(B) brain performance: headache, dizziness is common. Mostly induced by emotional excitement, excessive fatigue, climate change or the withdrawal of antihypertensive drugs. The blood pressure has risen sharply. Severe headache, visual impairment, nausea, vomiting, convulsions, coma, transient hemiplegia, aphasia, etc.
(C) cardiac performance: early, cardiac function compensation, symptoms are not obvious, late, cardiac function decompensation, heart failure occurs.
(D) kidney performance: long-term hypertension caused by renal arteriosclerosis. When kidney function is reduced, it can cause nocturia, polyuria, urine containing protein, casts and red blood cells. Poor urine concentration, phenol red excretion and urea clearance disorders. Nitrogenemia and uremia occur.
(5) Arterial changes.
(6) Fundus changes.
Second, acute hypertension: also known as malignant hypertension, accounting for 1% of hypertension, can be suddenly changed from the slow-moving type, but also can start. Malignant hypertension can occur at any age, but it is most common in 30-40 years old. The blood pressure is obviously increased, and the diastolic blood pressure is more than 17.3Kpa (130mmHg). There are symptoms such as fatigue, thirst and polyuria. Vision rapidly diminished, retinal hemorrhage and exudation in the fundus, often bilateral optic nerve head edema. Rapid proteinuria, hematuria and renal insufficiency. Heart failure, hypertensive encephalopathy and hypertensive crisis can also occur, and the course progresses rapidly to death from uremia.
Diagnosis
Differential diagnosis
Urinary bilirubin negative: the use of urinary bilirubin, urinary bilirubin and blood bilirubin can help identify the cause of jaundice. Urine bilirubin negative is hemolytic jaundice. Hemolytic jaundice is mainly caused by the intrinsic defects of red blood cells or the damage of red blood cells by exogenous factors, which causes the red blood cells to be destroyed a lot, releasing a large amount of hemoglobin, resulting in an increase in the content of non-lipid bilirubin in plasma, exceeding the processing capacity of hepatocytes. Then there is jaundice.
Phenylalanine metabolism disorder: common in phenylketonuria (PKU), is a hereditary disease caused by phenylalanine hydroxylase (PAH) deficiency or decreased activity leading to phenylalanine metabolism disorders. It is more common in hereditary amino acid metabolism-deficient diseases. The genetic pattern of this disease is autosomal recessive inheritance. The clinical manifestations were not uniform. The main clinical features were mental retardation, mental and neurological symptoms, eczema, skin scratch marks, pigmentation and rat odor, and abnormal EEG.
Increased urinary estrogen: Determination of estrogen in the urine, there are three main types of estrogen in the urine, namely estrone, estradiol and estriol. Estrogen has different normal values in different stages of menstrual cycle in women of childbearing age. In the first 7 days of menstrual cycle, estrogen levels are very low, and then rise with the development of follicles, reaching a peak on the 13th day, called ovulation peak. After a sudden decline, it gradually rose, and reached the peak on the 21st day, called the peak of the corpus luteum. Later, it will drop to menstrual cramps. Functional uterine bleeding estrogen levels are maintained below normal levels. The level of estrogen in uterine amenorrhea is normal, but the ovarian function is defective or the congenital ovary is not developed and causes amenorrhea. The estrogen level is low, but there is no periodic change. The pituitary or subthalamic amenorrhea, the estrogen level is generally lower. .
Hyperuricemia metabolism: hyperuricemia, also known as gout, is a group of diseases caused by dysbial metabolic disorders. Its clinical features are hyperuricemia and the resulting recurrent gouty acute arthritis, tophi Sedimentation, tomphitic chronic arthritis and joint deformities often involve the formation of chronic interstitial nephritis and uric acid kidney stones in the kidney. The disease can be divided into two major categories: primary and secondary. The cause of primary disease is mostly unclear due to a small number of enzyme defects. It is often accompanied by hyperlipidemia, obesity, diabetes, hypertension, arteriosclerosis and crown. Heart disease, etc., is a hereditary disease. Secondary people can be caused by a variety of causes such as kidney disease, blood diseases and drugs.
