Hypertensive nephropathy whole solution

Benign arteriolar nephrosclerosis Department of hypertensive renal disease caused by essential hypertension (also known as hypertension, renal arteriosclerosis) and malignant renal arteries harden, and accompanied by appropriate clinical manifestations of the disease.

Clinical manifestations

Some clinical manifestations of renal hypertension and essential hypertension vary, most patients with essential hypertension facial flushing, the "good cop hypertension," said. And renal hypertensive patients due to decreased renal function and with renal anemia, pale and thus, the "bad cop hypertension," said. In addition, patients with renal hypertension diastolic blood pressure based, higher incidence of young people. The main difference between the two lies in renal hypertensive kidney disease based, and essential hypertension occurs early retinopathy. Therefore, renal hypertension and essential hypertension treatment both in common, there are also differences. Renal vascular hypertension is a sexually transmitted disease or kidney substantive changes to the basis of traditional Chinese medicine treatment method is more complex.

[Diagnosis]

First, the medical history and symptoms

Over the age of 40 to 50 years of age, history of hypertension over 5 to 10 years. Only early nocturia, followed proteinuria, individual cases can occur due to broken capillaries transient hematuria, but not with significant low back pain. Often associated with arteriosclerotic retinopathy, left ventricular hypertrophy, coronary heart disease, heart failure, cerebral arteriosclerosis, and (or) history of cerebrovascular accident. Slow progression, gradually developed into a small part of renal failure, most perennial mild renal impairment and abnormal urine. Malignant hypertension diastolic take more than 16Kpa (120mmHg), accompanied by significant and rapid development of cardiovascular complications, proteinuria, often accompanied by hematuria, renal function decline.

Second, the examination found

General persistent elevated blood pressure (20.0/13Kpa, 150/100mmHg above); Some of the eyelids and / or lower extremity edema, heart community to expand, etc.; most arteriosclerotic retinopathy, when the fundus stripes, flame-shaped hemorrhage and cotton wool soft exudates, supporting the diagnosis of malignant renal atherosclerosis. Hypertensive encephalopathy may be accompanied by a corresponding neurological signs of localization.

Third, laboratory examinations

(A) mostly mild to moderate proteinuria, 24 hours more than in quantitative 1.5 ~ 2.0g; microscopic physical components (red blood cells, white blood cells, transparent tube type) less, may have hematuria; early serum uric acid, urine NAG enzyme , β2-MG increased, urine concentration - diluted dysfunction; Ccr multi slow decline, blood urea nitrogen, creatinine increase. Multiple renal tubular dysfunction precedes glomerular dysfunction.

(B) imaging the kidney and more change, development-induced renal failure occurs when the kidneys can be reduced to varying degrees; radionuclide appears early detection of renal damage; electrocardiographic left ventricular high voltage often prompts; chest X-ray or echocardiogram often Tip primary atherosclerosis, left ventricular hypertrophy, or enlarged.

(C) difficulties in clinical diagnosis should be made early biopsy.

Fourth, the differential diagnosis of a variety of secondary hypertension should be the exception, especially chronic nephritis hypertension type. Malignant renal atherosclerosis should be rapidly progressive glomerulonephritis, systemic vasculitis disease phase identification.

[Conventional treatment]

Western medicine treatment


An early, mild hypertension and normal urine may be substantially non-drug therapy to maintain a good mood, weight loss, salt restriction, limit alcohol, qigong and tai chi, proper physical exercise.

Second, the available choice of antihypertensive drugs: ① diuretics; ② β-blockers; ③ calcium antagonists; ④ angiotensin converting enzyme inhibitors (ACEI). Including calcium antagonists, ACEI on renal hemodynamics more favorable, ACEI reduce urinary protein than other antihypertensive drugs. Effective control of blood pressure to normal or near normal (18.7/12kPa, 140/90mmHg) can prevent, or delay stable hypertensive renal damage.

Third, patients with malignant renal atherosclerosis rapid deterioration of renal function in the short term, the merger had hypertensive encephalopathy, visual acuity decreased rapidly, intracranial hemorrhage, and not oral medications can be administered intravenously, commonly used sodium nitroprusside, and strive to 12 ~ 24 hours to control blood pressure. Minoxidil can quickly lower blood pressure, appropriate initial treatment of malignant hypertension.