OVERVIEW
Malignant hypertensive small arterial nephrosclerosis is mainly characterized by necrosis of small renal arteries, proliferative endarteritis and glomerular fibrin-like necrosis. Most patients present with varying degrees of renal failure, which can progress rapidly to death if left untreated.
Etiology
Secondary hypertension due to glomerulonephritis, chronic renal failure, renal artery stenosis, renal vasculitis, and rare endocrine disorders (pheochromocytoma, primary aldosteronism) is the main cause of the development of malignant hypertensive small artery nephrosclerosis.
Symptoms
Symptoms of malignant hypertensive small arterial nephrosclerosis include hypertension, renal involvement, hematuria, hematuria with proteinuria, fundus hemorrhages and exudates, and an enlarged heart. The diagnosis is based on the presence of persistent diastolic blood pressure >130 mmHg, neuroretinopathy and other clinical signs of cardiac and renal involvement.
Pathological changes, proliferative endarteritis of small arteries and fibrinoid necrosis of the entry arterioles are characteristic of malignant small arterial nephrosclerosis, and interlobular arterioles and smaller arterioles characteristically present with proliferative endarteritis and thickening of the arterioles due to concentric layering of the collagen, showing an “onion-skin” appearance and causing complete occlusion of the vessels. Complete occlusion.
Examination
1. Urinalysis
Includes proteinuria (sometimes in the context of nephropathy) and microscopic hematuria/hematochezia.
2. Physical examination
Neuroretinopathy (hemorrhages, exudates and often papilledema) is present. Enlarged heart with evidence of ventricular hypertrophy.
3. Hematologic examination
Blood abnormalities (microangiopathic hemolytic anemia, disseminated intravascular coagulation) are common. Very high levels of renin and aldosterone are typical.
Diagnosis
Diagnosis is made on the basis of etiology, clinical presentation and relevant investigations.
Differential diagnosis
All kinds of secondary hypertension should be excluded, especially the hypertensive form of chronic nephritis. Malignant renal small arteriosclerosis should be differentiated from acute nephritis and systemic vasculitis.
1. Chronic glomerulonephritis
Refers to a variety of etiological causes of different pathological types of bilateral glomerular diffuse or focal inflammatory changes, clinical onset of insidious, long duration of the disease, the condition of slow development of a group of primary glomerular diseases, so strictly speaking, it is not an independent disease.
2. Arteriosclerosis
Atherosclerosis is a kind of non-inflammatory lesion of arteries, which is a general term for degenerative and proliferative lesions of arterial wall thickening, hardening, loss of elasticity and narrowing of the lumen, and the common ones are: atherosclerosis, arterial calcification, and atherosclerosis of small arteries.
Complications
Complications arising from elevated blood pressure are common in the nervous system, cardiovascular system, and hematologic system, and are more serious when accompanied by severe hypertension and acute renal failure.
Treatment
Although some patients resolve spontaneously, aggressive reduction of blood pressure and management of renal failure can significantly reduce mortality and morbidity. With effective antihypertensive therapy, most patients remain at risk for moderate to severe vascular damage and continued progression of coronary, cerebrovascular, and renal disease. Patients with progressive renal insufficiency can be maintained on dialysis, with occasional improvement in renal function and discontinuation of dialysis. It is important not to lower blood pressure too quickly or too aggressively to avoid renal, cerebral or coronary ischemia.
Prevention
1. Exercise
Strengthen physical exercise, increase the body’s resistance, pay attention to the combination of work and rest, every day you can insist on walking, to the extent that the self does not feel fatigue, but also qigong exercise, playing taijiquan, do fitness exercises, in order to enhance the physical fitness, improve the body’s resistance to prevent colds and flu, and to prevent the condition from worsening due to respiratory infections and other triggers.
2. Pay attention to diet
Low-salt diet is very important. It is not suitable to eat diet containing too much fat. Excessive fat in the diet is prone to renal arteriosclerosis, which makes the kidneys atrophy and degenerate and causes arteriosclerotic nephropathy.
4. Symptomatic care
5.Leisure and work
Participate in social activities as little as possible, once the patient is diagnosed with kidney disease, in the beginning stage, should be mainly rest, active treatment, observation of changes in the condition, if the condition improves, oedema subsides, blood pressure returns to normal or close to normal, urinary protein, red blood cells and various types of tubular micro-volume, renal function stabilization, then 3 months later can start to engage in light work, avoid strong physical labor, prevent respiratory and urinary tract infections occurring.
6. Fertility and sexual life
For patients with kidney disease sexual life depends on the specific circumstances, in principle, do not advocate banning, in order not to cause disease aggravation to the extent.