History and symptoms
More than 40 years of age in the age of more than 50 years, hypertension history of more than 5 ~ 10 years. In the early stage, only nocturnal urine increased, followed by the emergence of proteinuria, inpidual cases can occur due to capillary rupture of transient gross hematuria, but not accompanied by significant low back pain. Often associated with atherosclerosis, left ventricular hypertrophy, coronary heart disease, heart failure, cerebral arteriosclerosis and / or cerebrovascular accident history. The progress of the disease is slow, a small number of patients gradually developed into renal failure, most of the renal function of mild damage and abnormal urine routine. The diastolic blood pressure of the patients with malignant hypertension should be more than 16Kpa (120mmHg), which is accompanied by obvious cardiac and cerebral complications and rapid development.
Two, physical examination found
The general blood pressure increasing (20, 0/13Kpa, 150/100mmHg); some of the eyelid and / or edema of lower limbs, heart boundary expanding; the majority of arteriosclerotic retinopathy, when soft exudative fundus stripes, hemorrhage and cottony, support the malignant renal arteriolar sclerosis diagnosis. Associated with hypertensive encephalopathy can have the corresponding neurological signs.
Three, auxiliary examination
(a) for mild to moderate proteinuria, 24 hours in more than 1 quantitative and 5 ~ 2, 0g; visible component microscopy (red blood cells, white blood cells, transparent tube type) may have less hematuria; early blood uric acid, urine NAG enzyme, beta 2-MG increased, urine concentration dilution dysfunction; Ccr how to slow down, blood urea nitrogen, creatinine. Renal tubular dysfunction precedes glomerular damage.
(two) imaging kidney without change, kidney can be reduced renal failure caused by development; examination of early renal damage; electrocardiogram often showed left ventricular high voltage; chest X-ray or echocardiography often suggest that aortic sclerosis, left ventricular hypertrophy or expansion.
(three) renal biopsy should be performed in the early stage of clinical diagnosis.
Four, differential diagnosis
Should be excluded from a variety of secondary hypertension, especially chronic nephritis hypertension. Malignant nephrosclerosis with rapidly progressive glomerulonephritis and systemic vasculitis disease identification.
1, early, mild hypertension and urine routine generally normal can be non drug treatment, to maintain good mood, weight loss, salt, wine, qigong and Tai Chi, proper physical exercise, etc..
2, malignant nephrosclerosis patients with short-term rapid deterioration of renal function, in patients with hypertensive encephalopathy, intracranial hemorrhage, visual acuity decreased rapidly and not oral drugs, can be used intravenously, sodium nitroprusside, and strive to 12 ~ 24 hours blood pressure control.
3, accompanied by hyperlipidemia, diabetes and hyperuricemia, should be given the appropriate treatment. At the same time the use of anti platelet aggregation and adhesion of drugs, such as Pan Shengding, aspirin, etc., may have a role in preventing renal arteriolar sclerosis.
4, renal insufficiency should also be given non dialysis treatment and replacement therapy.
5, to maintain smooth stool, should use pills, pills mo. Traditional Chinese medicine should be treated with Radix Bupleuri, orange, orange, etc..
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