Treatment of renal hypertension

Hypertension, renal hypertension symptoms also exists , not repeat them. Here are just some of the special aspects of the performance of renal hypertension make a profile .
Compared with the same level of essential hypertension, renal hypertension essential hypertension compared with more progress to malignant hypertension , which occurs in approximately 2 -fold. Which , IgA nephropathy , especially sclerosis , or hardening of IgA nephropathy secondary to malignant hypertension , especially common. Also, comparison with primary malignant hypertension , renal parenchymal malignant hypertension worse prognosis , some authors statistics , the former five-year kidney survival rate was 60%, while the latter one and a half years renal survival is only 4 %.
Renal hypertension is often severe retinopathy , cardiovascular and cerebrovascular complications occur more often . This is because in addition to hypertension, other cardiovascular risk factors often compound the presence of renal parenchymal disease, such as lipid metabolism disorder nephrotic syndrome , and glucose metabolism during diabetic nephropathy , anemia, renal insufficiency , and hyperuricemia disease, high homocysteine ​​, uremic toxins, metabolic acidosis , and micro- inflammatory state , these complex factors will significantly increase the incidence of cardiovascular complications.
In this , the need to emphasize that especially affect renal hypertension and chronic kidney disease on the basis of glomerular disease progression. Chronic glomerular disease was before glomerular arterioles diastolic state, the system is very easy to pass the glomerular hypertension , resulting in glomerular hypertension, high perfusion and high filtration, this "three high " that can accelerate the remaining glomerulosclerosis ; Meanwhile , long-term high blood pressure can lead to kidney arteriosclerosis , including hyaline afferent arterioles , interlobular artery and arcuate artery intimal thickening of the muscle , so that small artery wall thickening luminal narrowing , secondary to renal ischemia
Damage ( glomerular ischemic collapse was to ischemic sclerosis , tubular atrophy and renal interstitial fibrosis ) . Therefore, renal hypertension is not well controlled will significantly accelerate renal parenchymal disease progression , creating a vicious cycle .
Urinary protein quantity glomerular disease , hypertension and kidney damage effect is more obvious , because both effects overlay. Now known proteinuria, especially in a large number of glomerular proteinuria can be caused by a high pressure, high perfusion and high filtration promote glomerulosclerosis ; And, filtered proteins ( including complement and growth factors , etc.) and in combination with protein certain substances ( including lipid and iron, etc. ) after being tubular reabsorption , tubular cells can activate the release of pathogenic factors ( such as transforming growth factor β , etc. ) to promote renal interstitial fibrosis. Therefore, in patients with renal hypertension with proteinuria , more should be strictly controlled hypertension.
2 drug treatment
A variety of kidney disease caused by hypertension , treatment principles are basically the same .
1 . The control of water and salt intake to reduce blood volume, it should be noted excessive reduction of blood volume , can worsen kidney function .
2 thiazide diuretics commonly used drugs, but creatinine clearance below 30ml/min , the diuretic effect is significantly reduced , it should use loop diuretics furosemide ( Lasix ) and ethacrynic acid ( uric acid ) etc. , potassium- sparing diuretics should be taboo when azotemia .
3 Buck angiotensin-converting enzyme inhibitors (ACEI) and calcium antagonists in renal hypertension applications, already subject to widespread attention. ACEI and angiotensin Ⅱ not only inhibit the degradation of bradykinin , but also the expansion of the sphere of small arteries , relieve the pressure increased glomerular reduce glomerular damage. Captopril (Captopril) for rapidly progressive hypertension particularly useful. Others such as hydralazine ( hydralazine ) , Minoxidil ( Minoxidil ) for control of hypertension with renal insufficiency are also effective .

4 hemodialysis for renal failure after medical therapy , often need dialysis , dialysis without disabling antihypertensive drugs, the effect of minoxidil satisfactory .