Symptoms of renal hypertension, early manifestations need attention

Nephrotic hypertension is arteriosclerosis of the kidney caused by hypertensive disease. It is most common in middle-aged people. Generally, patients have a long history of hypertension. In the early stages, the urine will increase, and then it will cause proteinuria. Timely examination and treatment are required.

1. Medical history and symptoms

Most of them are over 40 to 50 years old, with a history of hypertension for more than 5 to 10 years. In the early stage, there is only increased nocturia, followed by proteinuria. In some cases, transient gross hematuria may occur due to capillary rupture, but it is not accompanied by obvious low back pain. They are often accompanied by arteriosclerotic retinopathy, left ventricular hypertrophy, coronary heart disease, heart failure, cerebral arteriosclerosis and (or) history of cerebrovascular accident. The disease progresses slowly, and a small number of them gradually develop into renal failure. Most of them often have mild renal damage and abnormal urine routine. Patients with malignant hypertension need to have a diastolic blood pressure of more than 16Kpa (120mmHg), accompanied by obvious cardiac and cerebrovascular complications and rapid development, large amounts of proteinuria, often accompanied by hematuria, and progressive renal function decline.

Second, physical examination found

Generally, blood pressure continues to increase (20.0/13Kpa, above 150/100mmHg); some have edema of eyelids and/or lower limbs, enlarged heart border, etc.; in most cases of arteriosclerotic retinopathy, when there are streaky, flame-shaped hemorrhages and cotton-like soft exudates in the fundus, it supports the diagnosis of malignant renal arteriolar sclerosis, and those with hypertensive encephalopathy may have corresponding neurological localization signs.

3. Auxiliary examination

(I) Most cases are mild to moderate proteinuria, with the 24-hour quantitative protein being between 1.5 and 2.0 g. Microscopic examination shows few formed elements (red blood cells, white blood cells, and hyaline casts), and hematuria may be present. In the early stage, blood uric acid is elevated, as are urine NAGase and β2-MG, and urine concentration-dilution function is impaired. Ccr usually decreases slowly, while blood urea nitrogen and creatinine increase. Renal tubular function damage often precedes glomerular function damage.

(ii) Imaging examinations usually show no changes in the kidneys. When renal failure develops, the kidneys may shrink to varying degrees. Radionuclide examinations show renal damage in the early stages. Electrocardiograms often show high left ventricular voltage. Chest X-rays or echocardiograms often show aortic sclerosis and left ventricular hypertrophy or enlargement.

(III) Renal biopsy should be performed at an early stage for those who have difficulty in clinical diagnosis.