The International Society of Nephrology (ISN) and the International Federation of Kidney Funds (IFKF) have jointly initiated the establishment of World Kidney Day on the second Thursday of March each year, with March 13, 2008 being the third World Kidney Day. The main purpose of establishing and promoting World Kidney Day is to draw global attention to chronic kidney disease (CKD) and related cardiovascular diseases, and to disseminate information about kidney disease to government health officials, all doctors and related professionals, individuals and families, in order to minimize this disease that is not yet fully recognized and valued by society. Killer I chronic kidney disease is a great stress and danger to society and individuals. Since 2002, our department has established a kidney club, which is held once a month, with the basic knowledge of kidney disease prevention and treatment lectured by attending physicians or above, and with interaction between doctors and patients, with 60-70 people attending each time. At the same time, we hold a large patient meeting once a year with more than 200 participants. Last year, we started to hold weekly lectures for hospitalized patients to increase the communication and exchange between doctors and patients, which is welcomed by everyone. Every year we organize physicians to give lectures to residents and medical staff in community and community hospitals. We feel that kidney disease is not fully recognized and adequately treated, especially early prevention and treatment, not only by general residents, but also by some medical staff and even expert directors of tertiary hospitals have misconceptions. One of the owners of our hospital once told me that his biggest regret was that his mother did not know that it was due to hypertension until she started peritoneal dialysis for her uremia, while she used to just take antihypertensive drugs and never checked her urine routine and kidney function. The problem with the treatment of kidney disease is that patients are too late in seeking medical attention and miss the best time for treatment. In fact, there are simple and easy methods for early detection and effective prevention and treatment, but they are not yet widely known and applied. Kidney diseases can be detected by simple routine methods such as blood creatinine and urine protein. Chronic kidney disease and related cardiovascular complications can be effectively prevented and treated, such as good blood pressure control, blood glucose control and lipid reduction. As a controllable disease, the focus of prevention and treatment is on early detection, early diagnosis and treatment, which is crucial to improve the prognosis of patients. At present, hypertension and diabetes have attracted the attention of the whole society, and government departments and health institutions have also given greater financial support and formulated more detailed prevention and treatment plans for the general public. The incidence of hypertension is increasing year by year, according to statistics, the number of patients with hypertension in the world is more than 600 million, and the number of hypertension in China is more than 100 million people. Hypertension can cause complications in the heart, brain, kidneys and other organs, and can lead to a high rate of disability and death, of which 74% of patients have heart complications, 32% have fundus lesions, 42% have kidney complications, and 10% of hypertensive patients die of renal failure. In a group of cases followed for 20 years, 12% of those with fundus examination showing fundus changes in hypertension grade I had proteinuria; 22% of those with grade II had proteinuria and 19% of men had decreased renal function; in grade II, 57% had proteinuria and 27% had decreased renal function. Therefore, the more severe the hypertension and the longer the duration of the disease, the higher the incidence of hypertensive nephropathy and renal failure. Classification of hypertension Hypertension can be divided into primary hypertension and secondary hypertension, primary hypertension accounts for about 90% of the population with hypertension, and hypertension caused by kidney disease accounts for about 10% of secondary hypertension, which is the first cause of secondary hypertension. Secondary hypertension is broadly divided into: 1 kidney disease, such as glomerulonephritis, pyelonephritis, tubulointerstitial nephritis, renal artery stenosis, diabetic nephropathy, etc.; 2 renin-secreting tumors; 3 cardiovascular disease, such as aortitis, atherosclerosis, etc.; 4 endocrine diseases, such as hyperthyroidism, pheochromocytoma, primary aldosteronism, etc.; 5 neurogenic, such as brain tumors, cerebrovascular accidents, etc.; 6 Hypertensive syndrome of pregnancy;7 Others, such as hypertension caused by oral contraceptives, glucocorticoids, licorice and other drugs. Factors affecting hypertensive renal damage The incidence of hypertensive renal damage is positively correlated with the severity and duration of hypertension. Other possible influencing factors include gender, race, diabetes mellitus, hyperlipidemia and hyperuricemia. Men are more likely to have kidney damage than women; hypertension is twice as common in blacks as in whites, and blacks are more likely to have kidney failure; hypertension and diabetes are both prevalent and common, and the combination of hypertension with insulin resistance, abnormal glucose tolerance, hyperinsulinemia, elevated very low-density lipoprotein, triglycerides, and reduced high-density lipoprotein cholesterol levels is called “syndrome X “, these factors interact with each other to further aggravate renal damage; hyperlipidemia can cause glomerulosclerosis and progressive development of renal lesions; hyperuricemia can be used as an early indicator of renal damage in hypertension, and hypertension with hyperuricemia can in turn aggravate its renal damage. Clinical manifestations The age of onset of primary hypertension is usually 25-45 years, while the age of onset of clinical symptoms of hypertension-induced renal damage is usually 40-60 years. The earliest symptom may be increased nocturia, reflecting that ischemic lesions have occurred in the renal tubules and that the concentrating function of urine has begun to diminish. Proteinuria then develops, indicating that the glomeruli have become diseased. The degree of proteinuria is usually mild to moderate (+ or ++), and the 24-hour urine protein quantification usually does not exceed 2 grams, although a few patients have massive proteinuria. Microscopic examination of the urine sediment shows few red blood cells and tubular patterns, and transient carnal hematuria occurs in individual patients due to rupture of glomerular capillaries. Complications of other organs, mainly cardiovascular, caused by essential hypertension can often be found, which may appear earlier and be more severe than renal damage and are the main or critical factors affecting prognosis. The most common cardiac complication is hypertensive left ventricular hypertrophy, which is also easily combined with heart failure and coronary angina; cerebrovascular complications are cerebral hemorrhage and cerebral infarction, and cerebrovascular accidents rank first among the causes of death from essential hypertension in China. Due to the widespread development of CT and transcranial Doppler examination, asymptomatic cerebral infarction and intracranial and extracranial atheromatous plaques and blood flow disorders are easily detected. Primary hypertension can cause retinal atherosclerosis, which further causes atherosclerotic retinopathy. Retinal sclerosis generally parallels the degree of small renal artery sclerosis and can generally reflect the condition of small renal arteries, so fundus examination is very important. The degree of retinal arteriosclerosis is directly proportional to blood pressure, with a closer relationship to diastolic blood pressure. Patients with hypertension who have a normal fundus are essentially free of hypertensive cardiac complications. Early renal damage in hypertension Patients with hypertension-induced renal damage have normal routine blood and urine tests before the appearance of clinical symptoms such as proteinuria and nocturia, but the application of more sensitive tests can reveal some abnormalities, which are the early renal damage in essential hypertension, including: 1. Increased urinary microalbumin excretion Especially seen in patients with inadequately controlled and newly developed severe hypertension The urinary microalbumin excretion can be reduced after the blood pressure is controlled. Increased urinary sediment erythrocyte count The morphological aberrations of erythrocytes can be observed with phase contrast microscopy and are due to damage to the glomerular capillary filtration barrier caused by hypertension. 3, Increased urinary β2 microglobulin excretion β2 microglobulin is now recognized as a sensitive indicator for measuring glomerular filtration rate and tubular reabsorption function. Newly discovered patients with severe hypertension and elderly patients with hypertension can have a significant increase in urinary β2 microglobulin, which can decrease after blood pressure control. 4, urinary NAG excretion increased renal tubular and urinary epithelial cells containing NAG, the amount of urinary excretion in renal damage can be up to 1200 times, and can be reduced after blood pressure control. Prevention of hypertensive renal damage If blood pressure can be satisfactorily controlled to normal or near normal, brain, heart and kidney complications are less likely to occur. Effective treatment of hypertension can prevent hypertensive renal damage and reduce the incidence of benign small artery nephrosclerosis end-stage renal failure in the elderly, and adequate control of blood pressure can prevent, stabilize, and even reverse hypertensive renal damage. For hypertension without comorbidities, non-pharmacological treatment should be considered first and can be the basic treatment for all other hypertensive patients, which includes weight loss, salt restriction, alcohol restriction, qigong and taijiquan practice, and appropriate physical activity, etc., and should be done consistently, all of which can receive a certain effect of lowering blood pressure. It is still controversial when to start antihypertensive treatment in patients with uncomplicated hypertension, but it is generally believed that drug treatment should be started in the following cases: 1) mild hypertension when non-pharmacological treatment is ineffective; 2) mild hypertension with coronary heart disease risk factors (such as high blood lipids) or family history of stroke or myocardial infarction; 3) moderate hypertension (diastolic blood pressure between 105 -114 mmHg); 4. Severe hypertension (diastolic blood pressure greater than 115 mmHg). There are five classes of drugs currently available as first-line antihypertensives;1 diuretics;2 beta-blockers;3 calcium antagonists;4 a-blockers.5 angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor antagonists (ARB). In the process of drug use, no matter which one or combination of drugs is chosen, as long as it can satisfactorily control hypertension are beneficial to prevent hypertensive renal damage, but for specific patients should be treated specifically, such as for young people with rapid heart rate at rest is more suitable for β-blockers, the elderly and high systolic blood pressure is more suitable for calcium antagonists, high plasma renin levels and combined diabetes is more suitable for At the same time, the side effects of drugs should be considered, such as diuretics can increase blood glucose, cholesterol and uric acid, and beta-blockers can increase serum triglycerides and lower HDL cholesterol. From the point of view of kidney protection, it is better to choose ACEI and ARB and calcium antagonists. Target blood pressure for therapeutic control The American Society of Hypertension has recently announced a blood pressure control target of 130/85 mm Hg. The new target of 130/80 mm Hg, based on clinical studies, is considered to be more helpful in halting the progression of kidney disease and reducing the risk of cardiovascular disease, especially in the elderly and diabetic patients, where blood pressure control below 130/85 mm Hg is more effective than conventional blood pressure lowering. The goal of 140/90 mmHg can save lifetime drug costs. A review of hypertension and diabetes studies since 1994 suggests that a blood pressure target of 130/80 mmHg is recommended for patients with diabetes and/or renal insufficiency; regardless of etiology, lowering blood pressure to less than 125/75 mmHg is recommended for urinary protein over 1 g/day and renal insufficiency; and lower blood pressure targets, regardless of the presence of renal disease, are more helpful than traditional blood pressure targets in reducing the risk of cardiovascular events in patients with diabetes. The risk of cardiovascular and cerebrovascular events in patients with diabetes is reduced by lower blood pressure targets than conventional blood pressure targets, regardless of the presence of renal disease.