Hypertensive nephropathy

　　Patients with hypertension need to control their blood pressure cautiously. Hypertension and renal injury can influence each other to some extent, and can jointly exacerbate the progression of the disease. Once the renal blood vessels are blocked or hardened, the renal blood flow becomes reduced, leading to a decrease in renal function, which constitutes a pathogen of hypertensive nephropathy.

　　Hypertension and kidney disease are intercausal, that is, kidney disease caused by hypertension can worsen hypertension, and hypertension also has a serious impact on the treatment of kidney disease. Because the blood flow of the kidneys accounts for about 1/5 to 1/4 of the cardiac output, and the kidneys are composed of many microvascular beds, hypertension undoubtedly harms the kidneys. Long-term hyperlipidemia leads to atherosclerosis and even blockage. If the lesion is located in the renal artery, renal infarction may occur; the patient will have proteinuria, and blood pressure will increase even more.

　　In addition to its clinical manifestations, hypertension and kidney disease can also cause other diseases. If hypertension and kidney disease are not treated in time, they may cause encephalopathy, hyperlipidemia, diabetes, and hyperuricemia, and should be highly emphasized by clinical doctors and patients.

　　The onset age of hypertension and kidney disease is mostly over 40-50 years old, with a history of hypertension for 5-10 years or more, early symptoms may include increased nocturia, followed by the appearance of proteinuria, and in some cases, transient gross hematuria may occur due to capillary rupture, but it is not accompanied by significant back pain. It often combines atherosclerotic retinopathy, hypertrophy of the left ventricle, coronary heart disease, heart failure, atherosclerosis of the cerebral arteries, and/or cerebrovascular accidents. The course of the disease progresses slowly, and a small number of patients gradually develop kidney failure. Most patients have mild kidney function damage and abnormalities in urinalysis. In patients with malignant hypertension, the diastolic pressure needs to exceed 16Kpa (120mmHg), accompanied by significant cardiovascular and cerebrovascular complications and rapid progression, with large amounts of proteinuria, often accompanied by hematuria, and progressive decline in kidney function.

　　Early prevention of hypertension and kidney disease is very important, and the following common preventive measures are listed:

　　1. Age over 40-50 years, with a history of hypertension for 5-10 years or more. If微量 albumin increase is confirmed, it should be highly alert.

　　2. Increase in nocturia, the appearance of proteinuria or transient hematuria, it is necessary to frequently check kidney function and urine protein quantification. 24-hour urine protein quantification, pay attention to blood pressure measurement, and perform fundus examination.

　　3. Keep the bowels通畅.

　　4. Avoid contact with heavy metals, toxic substances, and drugs that may damage the kidneys.

　　When there are hypertension and proteinuria in physical examination and urine examination, it is necessary to consider the possibility of hypertension and kidney disease, and blood tests and kidney biopsy can be used to confirm the diagnosis. Imaging examination of the kidneys usually shows no changes, and when kidney function failure develops, the kidneys may shrink to varying degrees; radionuclide examination shows renal function damage in the early stage; electrocardiogram often indicates high voltage in the left ventricle; chest X-ray or echocardiography often indicates atherosclerosis of the aorta, hypertrophy or dilation of the left ventricle.

　　Patients with hypertension and kidney disease should eat less sugary foods: For patients with hypertension and kidney disease, sugary foods have a high sugar content that can be converted into fat in the body, which is easy to promote atherosclerosis. Eat less animal fat: Animal fats contain a high cholesterol content, which can accelerate atherosclerosis. Liver, kidneys, brain, heart, and other organs should be eaten less.

　　Quit smoking and reduce alcohol intake: Hypertensive patients with a smoking and drinking habit may suffer from heart, brain, and kidney damage due to excessive smoking and drinking. It is advisable to eat more potassium-rich foods, as potassium can buffer the effect of sodium in the body. Foods include: soybeans, mung beans, tomatoes, zucchini, celery, fresh mushrooms, and various green leafy vegetables; fruits include oranges, apples, bananas, pears, kiwis, persimmons, pineapples, walnuts, watermelons, etc. Eat more foods rich in high-quality protein and vitamins, such as fish, milk, lean meat, eggs, beans, and bean products.

　　High blood pressure kidney disease does not require medication when there are basically no symptoms in the early stage. The treatment of this disease requires vigilance against the occurrence of complications, and general treatment methods include the following:

　　First, early and mild hypertension with roughly normal urine routine can be treated without medication, maintaining good mood, weight loss, salt restriction, alcohol restriction, practicing Qigong and Tai Chi, appropriate physical exercise, etc.

　　Second, antihypertensive drugs that can be selected: 1. Diuretics; 2. β-blockers; 3. Calcium channel blockers; 4. Angiotensin-converting enzyme inhibitors (ACEI). Calcium channel blockers and ACEI are more beneficial to renal hemodynamics, and ACEI is superior to other antihypertensive drugs in reducing urinary protein. Keeping blood pressure effectively controlled at normal or near normal (18.7/12kPa, 140/90mmHg) can prevent, stabilize, or delay renal damage caused by hypertension.

　　Third, patients with malignant renal arteriosclerosis may experience a rapid deterioration of renal function in the short term. When complications such as hypertensive encephalopathy, rapid decline in vision, intracranial hemorrhage, and inability to take oral medications occur, intravenous administration can be given, commonly using sodium nitroprusside, striving to control blood pressure within 12-24 hours. Long-acting nifedipine can quickly lower blood pressure and is suitable for the initial treatment of malignant hypertension.

　　Fourth, for those with concurrent hyperlipidemia, diabetes, and hyperuricemia, appropriate treatment should be given. At the same time, antiplatelet aggregation and adhesion drugs such as dipyridamole and aspirin may have the effect of preventing renal arteriosclerosis.

　　Fifth, when there is renal insufficiency, non-dialysis treatment and substitute treatment should also be given.

　　Sixth, keep the bowels open, it is advisable to use Qingning Wan, Mojia Qingning Wan. Traditional Chinese medicine should be used with Chaihu Zhizi Decoction, Tianma Gouteng Drink, etc.