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Hypertensive nephropathy

  Hypertensive renal disease (hypertensive renal disease) is caused by primary hypertension of benign small arterial nephrosclerosis (also known as hypertensive renal arteriosclerosis) and malignant small arterial nephrosclerosis, accompanied by the corresponding clinical manifestations of the disease.

  Basic overview Edit

  Hypertensive nephropathy Department of hypertension caused by benign small arterial nephrosclerosis (also known as hypertensive renal arteriosclerosis) and malignant renal arteriosclerosis associated with the corresponding clinical manifestations of hypertension and renal failure.

  More than a history of hypertension, renal tubular damage more early in the glomerular, nocturia increased, decreased urinary concentration, urine specific gravity becomes lighter, with mild proteinuria, may have microscopic hematuria and tube, often Other target organ complications of hypertension.

  Clinical manifestation editor

  Severe edema: edema often as the first symptom, was significantly edema systemic, acupressure depression. Severe patients may have pleural effusion, ascites, pleural effusion, ascites can cause more breathing difficulties, umbilical hernia or inguinal hernia. High edema often accompanied by oliguria, hypertension, mild azotemia.

  A large number of proteinuria: a large number of proteinuria is the most important manifestation of nephrotic syndrome, urine protein qualitative mostly ++ ~ ++++, adult daily urinary protein excretion ≥ 3.5g / d, mostly for selective proteinuria.

  Hypoproteinemia: plasma protein decreased serum albumin <30g / L, severe cases less than 10g / L.

  Hyperlipidemia: blood cholesterol, triglyceride, etc. were significantly higher.

  Disease stage editing

  Clinically, according to the situation of patients and laboratory data, we will be divided into the following period of hypertensive nephropathy, to provide a theoretical basis for treatment:

  Phase Ⅰ - microalbuminuria period: to urinary albumin excretion rate is characterized by abnormalities. Renal function normal, urine protein negative;

  Phase Ⅱ - clinical proteinuria: the urine protein positive, 24h urinary protein quantification> 0.5g is characterized by normal renal function.

  Ⅲ - renal insufficiency: to Ccr decreased, characterized by elevated SCr. Non-dialysis and dialysis (uremia).

  Non-dialysis: Ccr in 40 ~ 10ml / min, 133μmol / L

  Dialysis period (uremia): Ccr <10ml / min. Scr> 707μmol / L.

  History and symptom editing

  Hypertensive nephropathy history and medical symptoms:

  More than 40 years of age in more than 50 years of age, history of hypertension over 5 to 10 years, only nocturia early increased, followed by proteinuria. Individual cases may occur due to capillary rupture of transient gross hematuria, but not with obvious. See low back pain often associated with atherosclerotic 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 mild renal damage and urinary abnormalities in patients with malignant hypertension, diastolic blood pressure need to exceed Kpa (mmHg), accompanied by significant heart and brain complications and rapid development of a large number of proteinuria, often accompanied by hematuria and renal function decline.

  Hypertensive nephropathy physical examination found:

  The majority of arteriosclerotic retinopathy, when the fundus has striped, flame-like bleeding and cotton-like soft seepage of the infiltration of the eye, , To support malignant renal arteriosclerosis, accompanied by hypertensive encephalopathy may have the corresponding signs of the nervous system.

  Self-test Notes Edit

  Attention to self - test blood pressure in family

  Family blood pressure monitoring need to select the appropriate blood pressure measuring instruments, and blood pressure measurement knowledge and skills training:

  1) Use a validated upper arm automatic or semi-automatic electronic sphygmomanometer (BHS and AAMI, ESH).

  2) family blood pressure is generally lower than the clinic blood pressure, hypertension diagnostic criteria for the 135 / 85mmHg, and office blood pressure of 140 / 90mmHg corresponding.

  3) Measurement scheme: There is no consistent plan. General recommendations to measure blood pressure every morning and evening, each measurement 2-3 times, take the average; blood pressure control is stable, can be measured 1 day per week blood pressure. For newly diagnosed patients with hypertension or unstable blood pressure, it is recommended to measure the blood pressure continuously for 7 days (at least 3 days), once every morning and evening, 2-3 times each time, and take the average blood pressure 6 days as the reference value.

  4) family blood pressure applied to: general blood pressure monitoring in patients with hypertension; white coat hypertension; refractory hypertension identification; evaluation of long-term blood pressure variability; adjuvant antihypertensive efficacy evaluation; prediction of cardiovascular risk and prognosis.

  5) It is advisable to record in detail the date, time, and all blood pressure readings of each measurement, rather than just the mean. Complete blood pressure records should be provided to the physician whenever possible.

  6) Family blood pressure monitoring is a feasible way to observe the long-term variability in several days, weeks or even months. In the future, the remote control system based on wireless communication and Internet will realize the real-time and digital monitoring of blood pressure.

  7) For patients with high mental anxiety, self-test blood pressure is not recommended.

  Diagnostic Editing

  Hypertensive nephropathy differential diagnosis:

  In addition to what should be secondary to hypertension, especially chronic nephritis hypertensive type of renal arteriosclerosis, should be progressive nephritis, systemic vasculitis and other diseases.

  How to take an editor

  Hypertension medication attention points

  First, avoid indiscriminate use of drugs

  There are many kinds of antihypertensive drugs, the role is not exactly the same. Some antihypertensive drugs are effective in this type of hypertension, and some antihypertensive drugs are effective in another type of hypertension. Medication type is not the way, antihypertensive effect can not give full play, and sometimes mistakenly believe that "antihypertensive drugs ineffective." Drug treatment of patients with hypertension should be under the guidance of a doctor, should be the severity and individual differences, classification treatment.

  Second, bogey blood pressure too hasty

  Some people once found that high blood pressure, wait for them to drop blood pressure immediately, free to increase the dose, it is prone to accidents. Short-term blood pressure is best not more than 20% of the original blood pressure, blood pressure drop too fast or too low will occur dizziness, fatigue, weight can also lead to ischemic stroke and myocardial infarction.

  Third, avoid a single drug

  In addition to light or just the onset of high blood pressure, try not to single drug, to combined medication, compound therapy. The advantage is synergistic effect, reduce the dose of each drug, offset side effects.

  Fourth, avoid unexpected blood pressure medication

  Some patients usually do not test blood pressure, medication alone feel. Feeling less timely service less, dizziness discomfort to increase the dose. In fact, the symptoms and severity of symptoms is not necessarily the same, low blood pressure will also appear dizziness discomfort, continue to take medicine is very dangerous. The correct approach is to measure blood pressure regularly, adjust the dose in time to maintain consolidation.

  Fifth, avoid intermittent antihypertensive drugs

  Some patients with antihypertensive drugs when the service stops, a high blood pressure eat a few pieces, blood pressure drop, immediately withdrawal. This intermittent medication, not only can not make blood pressure stability, but also make the disease progression.

  Six, avoid asymptomatic without medication

  Some hypertensive patients usually asymptomatic, blood pressure was found only when high blood pressure. Dizziness after treatment, headache, discomfort, simply withdrawal. Long medication, can make the condition worse, blood pressure and then rise, leading to cardiovascular and cerebrovascular disease. Facts show that asymptomatic hypertension is not light, once discovered, should adhere to medication under the guidance of doctors, so that blood pressure stable at normal levels.

  7, bogey antihypertensive drugs before going to bed

  Clinical findings, before bedtime antihypertensive drugs prone to induce cerebral thrombosis, angina pectoris, myocardial infarction. The correct way is 2 hours before bedtime medication.

  Nursing editor

  Hypertensive care

  First, the definition of hypertension as systolic blood pressure ≥ 140mmhg and (or) diastolic blood pressure ≥ 90mmhg.

  Second, the common symptoms are: headache, dizziness, neck plate tight, fatigue, palpitations and so on.

  Third, blood pressure with the seasons, day and night, mood, activity levels and other factors have greater volatility. Such as: high blood pressure in winter, lower in summer; general night low blood pressure, wake up in the morning after the rapid rise in blood pressure, the formation of morning blood pressure peak.

  Fourth, pay attention to matters:

  1, bogey emotional anxiety, sadness, worry, anxiety and other negative emotions and tension and fatigue, easily lead to systemic vasoconstriction, rapid heartbeat, blood pressure. Listen to music to see the pictorial.

  2, avoid excessive fatigue fatigue can increase the hypertension, should maintain adequate sleep and reasonable exercise, such as walking Tai Chi and so on. Do not strenuous exercise, rapid change position.

  3, avoid eating too full diet easy to cause indigestion, at the same time due to eating full so that the diaphragm on the move, affecting the normal activities of the heart and lungs. At the same time excessive drinking, especially drinking strong wine will make blood pressure.

  4, avoid indiscriminate use of drugs Hypertensive patients according to different conditions and individual differences, treatment is not the same medication. Should be prescribed, on time, according to the amount of medication.

  5, bogey stool dry constipation Jiejie stool to be forced to force, so that blood pressure will rise sharply, the blood pressure and relaxation when the sharp decline, it is easy to cause stroke and myocardial infarction, it should maintain smooth stool.

  Fifth, the diet of patients with hypertension:

  1, diet section: three meals a day, regular quantitative, not too hungry, not overeating.

  2, balanced diet: a variety of food with a reasonable, balanced diet.

  3, scientific drinking water: try to drink hard water, such as springs, deep well water, natural mineral water.

  4, diet should be light: diet should be light, should be high in vitamins, high-fiber, high calcium, low fat, low cholesterol diet. Suggested to eat whole grains, grains, fresh vegetables, milk, fruit, soy products, lean meat, fish, chicken and other food, it is recommended vegetable oil, eat lard, greasy food and sugar, spicy, tea, coffee.

  5, reduce the amount of salt: daily salt control in less than 2-5 grams.

  Check the edit

  Early diagnosis of renal failure, routine renal function (creatinine, urea nitrogen) examination, abnormal, indicating that renal function has been damaged by more than 50%, so how early diagnosis of renal damage, is the way patients want to know. Clinical diagnosis of blood cystatin C or a trace of urine protein. [1]

  Auxiliary examination

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

  2, most of the renal imaging did not change, the development of renal failure caused by varying degrees of reduced renal; radionuclide examination early renal damage will occur; ECG often shows high left ventricular voltage; chest X-ray or echocardiography often Suggesting aortic sclerosis, left ventricular hypertrophy or enlargement.

  3, clinical diagnosis of early difficulties in renal biopsy.

  Harm edit

  Hypertension is very serious harm, if not promptly controlled, will damage the kidney damage caused by renal tubules, severe cases, renal failure will result in blood pressure caused by stroke, heart disease, severe cases will die; Of the renal bone disease, resulting in fragile bones of the human body. So do not underestimate the harm of hypertensive nephropathy. [2]

  ① severe edema, systemic edema, when you press down to go down, but also associated with reduced urine output and symptoms of hypertension.

  ② produce a lot of proteinuria, indicating that the glomerular filtration membrane decreased, so that a lot of proteinuria to the urine.

  ③ plasma protein, blood cholesterol, triglycerides will be increased.

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