Benign arteriolosclerosis of the kidney caused by primary hypertension in the elderly

　　Benign arteriolosclerosis is caused by long-term uncontrolled benign hypertension, resulting in higher blood pressure, longer duration, and more severe lesions. The main arterial lesions are the hyaline change of the wall of the afferent arteriole and the thickening of the intima of the interlobular artery and arcuate artery, causing ischemic renal parenchymal damage.

　　The common complications of benign arteriolosclerosis of primary hypertension in the elderly include retinal arteriosclerosis and hemorrhage, exudation, hypertension heart disease, cerebrovascular lesions, etc., and will also be accompanied by various clinical manifestations caused by increased blood pressure, such as serious hypertension and acute renal failure. The clinical classification of this disease can be divided into benign and malignant, the former has a longer course, generally 20 years; the latter develops rapidly, renal function deteriorates rapidly, and enters renal function uremia in a short period of time, often accompanied by multi-organ dysfunction such as heart and brain.

　　The renal tubules are more sensitive to ischemia, so the earliest clinical symptom is often polyuria at night (when the amount of urine at night exceeds half of the total urine volume, it is considered as polyuria, which is an manifestation of renal tubular concentrating dysfunction). At this time, the determination of renal blood flow and urine osmotic pressure (which reflects renal tubular concentrating function) has decreased to varying degrees, but the creatinine clearance rate (the most sensitive renal glomerular function test) is still normal, and the protein in urine routine examination and microscopic examination are all negative. Some scholars have found that at this time, if sensitive immunological methods are used to detect urinary albumin in patients, the excretion rate of urinary albumin is often increased, but its clinical significance is still unclear. Due to the fact that some patients with hypertension have a short history, the excretion of urinary albumin also increases when the blood pressure is significantly increased, and it returns to normal after blood pressure control, so many scholars believe that the increased excretion rate of urinary albumin does not reflect the ischemic glomerular lesions, but is caused by renal glomerular hemodynamic changes (hypertension leads to increased intraglomerular pressure).

　　After the occurrence of ischemic glomerular lesions, protein appears in the urine routine examination, and mild abnormalities (a small amount of red blood cells and granular casts) also gradually appear in the sediment microscopy. The urinary protein caused by ischemic glomerular lesions is generally not much, usually not exceeding 1g/d. However, when the blood pressure is very high, the intraglomerular pressure also increases accordingly, and the excretion of urinary protein can be significantly higher than this amount. Nevertheless, it will not reach the category of massive proteinuria (≥3.5g/d).

　　Hypertension history is the main cause of this disease. In order to prevent the occurrence of this disease, everyone should pay attention to the following lifestyle issues:

　　1. Keep an open mind, pay attention to combining work and rest, actively participate in cultural and sports activities, and physical laborers should persist in certain physical activities, which is conducive to maintaining the normal function of the central nervous system.

　　2. Carry out mass preventive and therapeutic work, conduct collective regular health checks, and follow up and observe those with a family history of hypertension and a record of increased blood pressure, which is beneficial for the early detection and early treatment of the disease.

　　3. Encourage each physician to include blood pressure measurement as a routine examination when diagnosing, which will help to identify asymptomatic early-stage hypertension patients and provide them with the opportunity to receive early treatment.

　　In addition, attention is also paid to factors that affect kidney damage in patients with primary hypertension, such as gender, race, diabetes, hyperlipidemia, and hyperuricemia. The prevention and treatment of kidney damage caused by primary hypertension not only focuses on effectively and satisfactorily controlling hypertension but also comprehensively considers other factors that can damage the kidneys and treats them accordingly.

　　This disease may present with increased serum creatinine, blood urea nitrogen, proteinuria, a small number of red blood cells, and granular casts, so it can be diagnosed by blood tests. B-ultrasound examination shows reduced kidney volume, which is helpful for diagnosis.

　　Diet has a tremendous impact on disease recovery, so how should patients with benign arteriolosclerosis of the kidney caused by primary hypertension in the elderly diet?

　　1. Limit sodium salt intake, first by reducing cooking salt, and it is advisable for each person to consume no more than 6g of salt per day.

　　2. Reduce dietary fat, supplement adequate protein, eat more vegetables and fruits, and consume sufficient potassium, magnesium, and calcium.

　　3. Alcohol intake is linearly related to blood pressure levels and the prevalence of hypertension. Hypertensive patients should abstain from alcohol or strictly limit it.

　　If blood pressure can be satisfactorily controlled to normal or close to normal[