Renal parenchymal hypertension

 

Renal parenchymal hypertension diagnosis depends on:

(1) history of renal parenchymal disease; proteinuria, hematuria and renal dysfunction occurred before or at the same time in hypertension; 

(2) physical examination often have anemia appearance, kidney mass Serum creatinine, uric acid, blood glucose, blood lipid determination; 24-hour urinary protein or urinary albumin / creatinine ratio (ACR (serum creatinine, urinary albumin, creatinine); ), 12h urinary sediment examination, such as proteinuria, hematuria and urinary white blood cells increased, you need to further the middle of urine culture, urine protein electrophoresis, urine phase contrast microscopy, clear urine protein, red blood cells and exclude infection; Kidney size and shape, and whether the tumor; found kidney volume and shape abnormalities, or found in the tumor, you need to do further renal CT / MRI to diagnose and check the cause; fundus examination; if necessary, the condition of the hospital line kidney Puncture and pathology, which is the diagnosis of renal parenchymal disease of the "gold standard." 

(4) renal hypertension and renal hypertension need to be caused by renal damage and pregnancy-induced hypertension phase identification, the former often preceded the occurrence of renal disease or hypertension at the same time with it; high blood pressure and difficult to control, easy to progress to Malignant hypertension; proteinuria / hematuria occurred early, severe degree, impaired renal function significantly. Pregnancy within 20 weeks of hypertension with proteinuria or hematuria, and prone to pre-eclampsia or eclampsia, there are still high blood pressure after childbirth, renal parenchymal hypertension. Renal parenchymal hypertension treatment should include low-salt diet (daily <6g); a large number of proteinuria and renal insufficiency, should choose a high intake of high-value protein, and limited to 0.3-0.6g / kg / d; In patients with proteinuria should be preferred ACEI or ARB as antihypertensive drugs; long-acting calcium channel blockers, diuretics, β-blockers, antihypertensive drugs, Α blockers can be used as a combination therapy drugs; such as glomerular filtration rate <30ml / min or a large number of proteinuria, thiazide diuretics ineffective, loop diuretics should be used in the treatment of about 90% of the kidney Essential hypertension is due to Shuinazhuliu and blood volume expansion due. When the renal parenchymal lesions make the kidneys lose excretion diet contains the right amount (not excessive) water, salt, it will cause water, sodium retention in the body, thereby causing excessive blood volume caused by high blood pressure. This mechanism occurs as long as there is mild renal insufficiency. Plasma renin and angiotensin II (A II) levels are usually low in these patients. its

  Hypertension can limit the water, salt intake or by dialysis to remove excess water, salt to achieve the purpose of lowering blood pressure. Whether unilateral or bilateral renal parenchymal disorders, almost every kidney disease can cause high blood pressure. Usually glomerulonephritis, lupus nephritis, polycystic kidney disease, congenital renal hypoplasia and other diseases, if the disease is more extensive and associated with vascular disease or renal ischemia more extensive, often accompanied by high blood pressure. For example, diffuse proliferative glomerulonephritis often due to extensive disease, severe renal ischemia, hypertension is very common; the other hand, minimal change, focal proliferative nephritis rarely hypertension. 

Renal tuberculosis, kidney stones, renal amyloidosis, hydronephrosis, pure pyelonephritis, renal medullary cyst disease and other major manifestations of interstitial damage of renal tubular lesions produce less chance of hypertension. However, these diseases once developed to affect glomerular function often appear high blood pressure. Therefore, the incidence of renal parenchymal hypertension and glomerular function status is closely related. Glomerular dysfunction, blood pressure tends to rise, end-stage renal failure, the incidence of hypertension up to 83%.