OVERVIEW
Hypertension-associated renal failure is a clinical syndrome in which blood pressure is elevated to a certain degree leading to renal impairment. According to the degree of urgency and duration of the disease, it can be divided into chronic renal failure and acute kidney injury, and hypertension-related renal failure is mainly chronic renal failure.
Causes
Hypertension is one of the most important complications of chronic kidney disease, chronic kidney disease is the most common cause of secondary hypertension, hypertension and renal damage coexist, interact, cause and effect each other, and aggravate each other.
Symptoms
There are both symptoms of hypertension and renal failure. When blood pressure is too high for patients to tolerate, headache, head swelling, insomnia, dreaminess, palpitation will occur; the main manifestations of renal failure include loss of appetite, nausea, vomiting, urine odor in the mouth, metabolic disorders of water electrolytes, protein, sugar, lipid, etc., and related pathological manifestations of the nervous, blood, respiratory, endocrine and other systems.
Examination
Serum creatinine test (SCr), micro clear proteinuria test, and estimated glomerular filtration rate are renal markers of hypertensive target organ damage. Renal damage can be considered when any of the following conditions are met.
1. Mildly elevated SCr, 115-133 μmol/L in men and 107-124 μmol/L in women.
2. Microalbuminuria 30～300mg/L, or clear protein/creatinine ratio >30mg/g.
3. Glomerular filtration rate is the best indicator for assessing renal filtration and overall renal function, but can only be estimated by blood clearance of creatinine.
Diagnosis
First, it must be clarified whether the patient has malignant hypertension, and if so, it should be further clarified whether the patient is already in a period of small artery necrosis and rapid deterioration of renal function. Fundus examination helps to establish the diagnosis of malignant hypertension, which is characterized by optic disc edema, retinal striae hemorrhagic, cotton-wool-like exudates and peripapillary stellate image changes. In addition to the history and clinical manifestations, the diagnosis of renal impairment needs to be clarified by auxiliary tests.
Treatment
Treatment is aimed at lowering blood pressure and reducing proteinuria. Strict control of hypertension is the key to slowing the progression of renal disease and preventing the risk of cardiovascular events. Early active and effective anti-hypertension can delay or reduce hypertension-induced renal damage, help reduce proteinuria, protect renal function, and reduce the occurrence of renal insufficiency. Among the six major classes of commonly used antihypertensive drugs, angiotensin-converting enzyme inhibitors (ACEI) and calcium channel blockers are usually preferred. Angiotensin II receptor blockers (ARBs) and/or ACEIs are preferred for diabetic adult CKD patients with urinary protein excretion of 30-300 mg/d or adult CKD patients with urinary protein excretion of >300 mg/d. Initial application of ARBs or ACEIs should be closely monitored for changes in renal function. A rise in SCr and/or a decrease in endogenous creatinine clearance of <30% within 2 months of administration can be continued under monitoring; however, >50%, the drug should be discontinued immediately. It should be used with caution in patients with severe renal failure and is contraindicated in patients with bilateral renal artery stenosis.