How can hypertensive patients judge whether there is renal damage?

Like diabetes, the sign of early renal damage in hypertensive patients is microalbuminuria. In addition to the rapid progress of hypertension, renal function damage and failure will soon occur, while the renal damage of general hypertension is slow.

Under normal circumstances, there is almost no albumin in urine. When hypertension damages the glomerular basement membrane, albumin with small molecular weight (relative to globulin) will leak out at the earliest time, resulting in proteinuria. Because less albumin begins to leak out, the urine is only 30mg 300mg/24h, so it is called microalbuminuria.

Why is the early renal damage caused by hypertension microalbuminuria? Because the glomerulus of the kidney is actually a blood vessel ball, all the blood in our body is filtered through the glomerulus to produce urine. Glomerulus has a filter membrane when filtering urine. Under normal circumstances, substances such as protein cannot be filtered out. When you have high blood pressure, the increased blood pressure will damage blood vessels, of course, it will also damage the glomerulus, damage the filtration membrane, and protein will leak out. At first, it was albumin with small molecular weight, which was seriously damaged, and protein with large molecules would also leak out. If more protein leaks, there will be a lot of proteinuria, and protein will be found in urine routine.

When microalbuminuria occurs, the patient can feel nothing, and the urine routine can't be displayed, and the result can be normal. However, if we specifically check the urinary microalbumin, we will find that the urinary albumin has increased. This shows that hypertension has caused kidney damage.

Because the early renal damage of hypertension is asymptomatic, once hypertension is found, urinary microalbumin should be checked as an evaluation of target organ damage. You know, when you find high blood pressure, you are not necessarily just high blood pressure. Maybe your blood pressure has already risen, and you didn't notice it. Therefore, when many patients find high blood pressure, their myocardium also increases (high blood pressure leads to heart disease), and there is also a small amount of albumin in urine (hypertensive kidney damage).

Check microalbuminuria, it should have been checked for 24 hours, because the amount of urinary protein excretion is different every time in a day. But leaving urine for 24 hours will be very troublesome for outpatients. So now do more morning urine tests, that is, morning urine. Note that morning urine is not the first time after getting up, but overnight urine. You have to pee twice in the morning, that's the real morning urine. Pay attention when leaving a urine sample.

Furthermore, in order to reduce the error, the ratio of urine protein to urine creatinine is often used to judge whether there is too much urine protein (normally 2.5 3.5 mg/mmol). If this ratio increases, it also means that there is too much urinary albumin.

How to do early renal damage (microalbuminuria) in patients with hypertension?

Lowering blood pressure is the first priority. Blood pressure should be below 130/80mmHg.

When choosing antihypertensive drugs, "Puli" and "sartan" antihypertensive drugs have better effects on reducing urinary protein, and can be selected according to the condition. However, patients with obvious renal insufficiency or renal artery stenosis should be cautious.

Normal blood pressure systolic blood pressure is between 90- 140mmHg, and diastolic blood pressure is between 60-90mmHg. If the blood pressure exceeds 140/90mmHg, it indicates hypertension. If the water pressure is high, the water pipes are easy to be damaged, and so are our blood vessels. If blood pressure is high for a long time, blood vessels will be damaged. The injury of coronary artery will lead to coronary heart disease, and the injury of cerebral artery will lead to cerebral infarction/cerebral hemorrhage. The kidney is also an organ with extremely rich blood vessels, and long-term hypertension has also done great damage to the blood vessels of the kidney. Renal damage caused by hypertension is called hypertensive nephropathy.

Hypertensive nephropathy, if left unchecked, will eventually develop into uremia. Primary glomerulonephritis, diabetic nephropathy and hypertensive nephropathy are the three main causes of uremia in China. Therefore, hypertensive nephropathy is a complication that every hypertensive patient should be alert to.

Then the question is, how do hypertensive patients judge whether renal function is damaged? In short, hypertensive nephropathy can be considered if proteinuria or glomerular dysfunction (such as elevated serum creatinine) occurs in patients with long-term hypertension.

How does hypertension have kidney damage? We treat hypertensive nephropathy not for radical cure, but for preserving renal function, delaying the progress of hypertensive nephropathy and avoiding uremia.

Controlling blood pressure is the most important thing to treat hypertensive nephropathy, and it is also the key to maintain renal function. ACEI/ARB antihypertensive drugs are the first choice for hypertensive nephropathy to control blood pressure. ACEI (captopril, enopril, etc. ) /ARB (irbesartan, valsartan, etc. ) Antihypertensive drugs help to reduce proteinuria and delay renal damage. Of course, other types of antihypertensive drugs are also applicable, the purpose is to control blood pressure smoothly! As for proper blood pressure control, the clinical guidelines recommend that the target for patients without proteinuria is 140/90 mmHg, and the target for patients with proteinuria is 130/80 mmHg. Patients over the age of 60 can appropriately relax their antihypertensive goals.

Renal damage in patients with hypertension does not depend on the number of urinary vesicles. Urinary protein can be significantly increased, but urinary vesicles are not necessarily proteinuria. However, once hypertensive patients have renal damage, the prognosis is poor. Whether renal damage occurs or not, it is necessary to judge the degree of renal damage, formulate treatment plans and evaluate the prognosis through blood and urine tests.

1. Proteinuria: Patients with hypertension have no acute nephropathy or diabetes. If protein appears in urine routine for more than three consecutive times, it is necessary to check the quantitative urine protein for 24 hours. In general, it should be less than 100mg- 150mg. If it exceeds 3000-3500mg, the prognosis is very poor. The causes of proteinuria are renal arteriosclerosis caused by long-term hypertension, glomerular stenosis and ischemia, and glomerular basement membrane damage under long-term hypertension. The increase of permeability causes excessive albumin leakage in blood.

2. Draw blood to check creatinine and urea nitrogen. If we can add an endogenous creatinine clearance rate, it will be more comprehensive. Creatinine is a metabolite after muscle exercise. Creatinine is the product of human muscle metabolism. In muscle, creatine slowly forms creatinine mainly through irreversible non-enzymatic dehydration reaction, and then it is released into the blood and excreted with urine. The normal value is 44- 133 umo/L, and each hospital has its own standards. Creatinine will only increase when the glomerular filtration rate is lower than 50%, and it is still within the normal range when there is mild renal damage. If creatinine is greater than 133umo/L, it can be defined as renal insufficiency; If it is greater than 186ump/L, it is renal failure; If it is greater than 45 1IMO/L, it is uremia.

Endogenous creatinine clearance rate is more sensitive than creatinine, and renal damage can be found earlier.

Urea nitrogen produces little creatine for the elderly who stay in bed for a long time or have little activity. Even if the renal function is poor, it can't show the increase of creatinine. Urea nitrogen is the final product of protein's metabolism. For example, the decline of glomerular filtration function can be reflected immediately.

3. Patients with chronic renal failure will have anemia due to the decrease of erythropoietin secretion by the kidney: yellow or pale face, pale eyelids, pale palms and nail beds.

Oliguria, edema and anuria are all manifestations of end-stage renal disease. As for what antihypertensive drugs can reduce urine protein, in fact, it is better to do it late than never. People with family history should prevent themselves from eating too much high-calorie food and getting fat from teenagers and even childhood. Low-salt diet and weight control are the most effective measures to prevent hypertension. It is also very important to insist on proper exercise every day, establish a good lifestyle, such as not smoking, drinking and staying up late, and learn and cultivate your own methods to adjust and relieve stress and emotions. Once you find that your blood pressure is rising, the most important thing is to get down, which is far more important than what medicine you choose. Lowering blood pressure is the last word, and there is only one reason to protect the heart, brain and kidney aorta: lowering blood pressure, persevere! I hope more people can get rid of high blood pressure.

20 18. 10.26

One of the more serious complications of hypertension is hypertensive nephropathy, and as we all know, it is very easy to cause the increase of blood pressure after the decline of renal function in nephropathy. In other words, the kidney is not only the target organ of hypertension damage, but also an important organ that causes hypertension. So these are two. He is my brother and helps each other.

In fact, nephropathy caused by hypertension is a chronic process in most cases, and the symptoms of early renal damage are not obvious. So these have caused many times, even if there is hypertensive renal damage, and the patient himself does not know it, and with the gradual aggravation of hypertensive renal damage, the symptoms slowly show up. In fact, early kidney disease is difficult to detect. The main cause of renal damage is hypertension, which is mainly systemic arteriosclerosis, which will lead to the decline of arterial elastic function. Renal artery involvement will cause chronic damage, especially persistent hypertension, and the speed of renal artery damage will be faster.

In addition, as a kidney, it is a silent organ. Before it appears obvious injury, it will continue to do its work silently and selflessly, until one day, it is too tired to do anything, and there will be obvious symptoms to remind you. From this point of view, hypertension causes kidney damage, and there will be no obvious symptoms in the early stage.

So we wouldn't know if it wasn't the symptoms caused by hypertension. Through some daily observations of the body, we can also know that hypertension has caused damage to the kidneys. Let's have a look. The main function of the kidney in the body is detoxification. The principle is that the kidney can produce urine, and then use urine as a guide to metabolize the waste and poison produced by the body. At the same time, it can absorb other useful substances needed by the body. Of course, the kidney also has endocrine function, producing erythropoietin, prostaglandin, kinin and so on. Because of these functions of kidney, the stability of human internal environment can be guaranteed.

In other words, if there is something wrong with the kidney, its function will decline and it will show corresponding symptoms.

For example, dysuria. The decline of renal function will affect micturition metabolism, which is manifested by the change of urine volume, especially the increase of nocturnal urine in the early stage, and some cases may have transient gross hematuria due to capillary rupture. But often such symptoms have not attracted enough attention.

Such as increased urine foam. If there is protein in urine, there will be a lot of foam in urine, but it doesn't mean that if there is foam urine, it must be renal damage proteinuria.

For example, kidney metabolic disorder causes listlessness, fatigue, fatigue and digestive tract discomfort, such as loss of appetite, abdominal distension and nausea and vomiting, but these symptoms are usually atypical.

For example, anemia is caused by decreased secretion of erythropoietin.

For example, with the progress of the disease, there are manifestations such as decreased urine volume and systemic edema. Edema may be only local edema in the early stage, systemic edema in the later stage and renal failure in the later stage.

In fact, for hypertensive renal function damage, it is mainly to check urine protein and renal function. For example, the 24-hour urine test protein is mostly1.5 2.0g, mostly mild to moderate proteinuria, and there are few visible components (red blood cells, white blood cells and transparent cast) in the diagnosis of hypertensive nephropathy, which may lead to hematuria. Renal function examination showed increased creatinine, etc. Through these tests, it is clear whether the renal function is damaged and the severity of the damage.

For friends with hypertension, we should always be alert to the occurrence of hypertensive nephropathy, because once severe hypertensive nephropathy occurs, it is often difficult to recover. In other words, daily hypertension management must be done well to avoid complications. Do the following daily: 1. The first problem is to control high blood pressure, especially to avoid violent fluctuations in blood pressure, monitor blood pressure regularly, and take timely measures to intervene when blood pressure rises.

2. In the daily life style, we should ensure adequate sleep, quit smoking and drinking, try to avoid heavy physical labor, and take appropriate physical exercise according to our own specific conditions.

3, the diet should control the amount of salt, low-salt and low-fat diet, control the consumption of animal fat, and reduce calorie intake. Eat more fruits and vegetables appropriately.

4, control other basic diseases, especially those with hyperlipidemia, diabetes and hyperuricemia, should be given corresponding treatment.

5, under the guidance of a doctor, the application of anti-platelet aggregation and adhesion drugs, such as aspirin enteric-coated tablets, may have the effect of preventing renal arteriole sclerosis.

To sum up, hypertension causes kidney damage, and the initial symptoms may not be obvious and atypical, but when there are obvious symptoms, it often reflects that renal function damage is more obvious, and treatment will be difficult at this time. Therefore, blood pressure must be controlled in daily life to prevent hypertensive kidney damage. I'm a general practitioner. I hope I can help you. Thank you for your attention and praise! The relationship between hypertension and kidney is close and complicated. The damage of hypertension to kidney mainly includes: ① Renal sclerosis: In the early stage of mild and moderate essential hypertension, the structure and function of kidney have not changed significantly for a long time, but renal arteriole spasm and renal self-regulation function are weakened, such as the ability to adapt to non-physiological states such as high sodium load and acute volume expansion. After a certain period of time, due to the continuous spasm of renal arteriole, renal arteriole degenerates, hardens and narrows, and nephron atrophy and hardens due to ischemia, which seriously damages renal function. First of all, renal tubular injury and functional changes occurred, and the patient developed nocturia. Laboratory tests show that there is a small amount of protein in urine, mainly small molecular protein (β2 microglobulin is its characteristic), the proportion of urine decreases, and uric acid capacity decreases. Generally, primary hypertension develops steadily, and mild to moderate renal arteriosclerosis may occur after 5 10 years. ② Renal atherosclerosis: Hypertension is an important pathogenic factor of atherosclerosis, and renal artery is the prone site of atherosclerosis. After renal arteriosclerosis, renal blood flow decreases, activating renin-angiotensin-aldosterone system, causing vasoconstriction, water and sodium retention, and further increasing blood pressure, forming a vicious circle. ③ About 7% patients with essential hypertension suddenly and progressively increased their blood pressure during the course of the disease, and turned into malignant hypertension. When blood pressure develops into acute hypertension, renal arterioles will suffer from cellulose necrosis, severe renal ischemia, rapid deterioration of renal function and rapid development into uremia.

At first glance, I ran to the age of forty, looking back on the past, vividly. Think of playmates who have experienced since childhood. Really, just like in the past, their faces will come to mind. One of my most unforgettable people is Haizi, my childhood playmate.

I remember when I was a child, Haizi was a black child. He is bigger than ordinary people, fights badly and is never bullied. But he is kind by nature and very kind to people. So I played with Haizi and became good friends. Later, I went to school in other places and had less contact with Haizi. During my years at school, I had little contact with my child, but I always remembered him. Later, in those years when I was in medical university, I heard that my child had not been properly diagnosed and treated because of long-term hypertension, and later developed into a stage of severe renal failure. Then Haizi disappeared. When I heard the news, I also cried with great heartache and regret. After all, that person used to get along with each other.

Having said that, I have to talk about the damage of high blood pressure to the kidneys, which is what we do every day. The biggest damage of hypertension is the heart, brain, kidney and other important organs of the human body, but the kidney should be the earliest one, so it is necessary to control hypertension well and control it well to protect the kidney.

Actually speaking, Dr. Zhang is not willing to convey the knowledge of medical books to everyone intact, which is also boring. Let me talk about my own clinical experience. Long-term hypertension can't be controlled. The damage of hypertension to the kidney is the damage of renal tubules at the earliest stage, and the symptoms can be manifested as nocturia. In laboratory examination, we can observe the existence of renal tubular injury by checking urine β2- microglobulin. If hypertension is still out of control after this stage, the glomerulus will be damaged. At this time, urinary protein, urinary microalbumin and even creatinine may increase.

In the face of these kidney injuries, how should we patients with hypertension respond? For me, the first thing you do is to control your blood pressure; Second, you can consider taking antihypertensive drugs with renal protection. Here are two special words to say. If the patient can tolerate it, try to control the blood pressure below 130/80mmHg. If antihypertensive drugs have no contraindications, you can consider using either sartan antihypertensive drugs or Pulitzer antihypertensive drugs.

The above are some introductions of Dr. Zhang on hypertensive renal injury. If you are in the early stage of hypertension, please regulate and control your blood pressure as soon as possible, otherwise the consequences will be unimaginable.

Long-term hypertension, if not controlled, can lead to renal arteriole atherosclerosis and renal dysfunction, which will further increase blood pressure and cause a vicious circle, and eventually renal function will continue to deteriorate and become uremia.

Hypertension can also cause kidney atrophy.

A normal kidney is round and full. Long-term hypertension will lead to renal atrophy, granular surface and decreased renal function.

So, what symptoms can help us to judge that hypertensive patients have renal damage?

1, the blood pressure that was originally controlled was ok, and suddenly it was out of control. Or the already high blood pressure has risen even higher.

As we said before, high blood pressure leads to the decrease of renal function, which in turn leads to the increase of high blood pressure (the kidneys cannot excrete excess water in the body).

Therefore, it is a good habit to monitor blood pressure every day.

2. There is proteinuria

The earliest renal damage is often manifested as microalbuminuria, which can not be judged by naked eyes and can only be found by urine test. With the aggravation of renal damage, there are more and more protein in patients' urine.

3. Hematuria

After the kidney is damaged, red blood cells will enter the urine, and the urine will be red.

4. Changes in urine volume

In the early stage of renal insufficiency, urine will increase, and then urine will decrease. The daily urine output of normal people is 1000-2000ml. If it is less than 400ml, then there is something wrong with the kidney.

5. Symptoms of nausea and anorexia appear.

This may also be a sign of kidney damage, which cannot be ignored.

6. Edema

When the kidney is damaged, edema first appears on the face, especially on the eyelids.

Hypertension patients often die of complications in the end, so controlling blood pressure, monitoring blood pressure every day and going to physical examination regularly are of great significance for preventing and delaying complications and finding them early.

Hypertension is not only harmful to your health, but also leads to other system diseases, such as heart-related diseases, kidney-related diseases, cerebrovascular diseases and eye diseases. Kidney injury is a common complication of hypertension, so what physical manifestations can we judge as kidney injury?

First of all, patients with long-term hypertension can go to the hospital for blood tests if they want to judge whether they have renal damage. The most important items about kidney are renal function and urine analysis. If the renal function is characterized by increased uric acid and serum creatinine, it can reflect kidney damage; If the color of urine changes, occult blood is positive, and even proteinuria can be used as a basis for judgment.

Secondly, when hypertension is found, we can check renal color Doppler ultrasound, adrenal color Doppler ultrasound and renal artery color Doppler ultrasound, which can not only find out whether there is renal damage, but also judge whether there is the possibility of secondary hypertension, so as to decide the further treatment plan.

Third, you can judge from the symptoms. If the kidney of hypertensive patients is damaged, the urine output will increase or decrease accordingly, especially at night. At the same time, there will be body swelling, and the more obvious parts are eyelids, lower limbs and other parts, so it can be judged by the above symptoms.

Once kidney injury is found, it must be checked and treated in time. If the disease develops further and uremia, renal failure and other diseases appear, it will be difficult to achieve good therapeutic effect.

Answer: Xu Xia, Master of Medicine.

Welcome to pay attention to Xinghua Island to gain more useful health knowledge. Uncontrolled hypertension really hurts the kidneys. Data show that renal damage caused by hypertension is the third leading cause of uremia dialysis after chronic glomerulonephritis and diabetes. The process of renal damage caused by hypertension is as follows:

(1) The kidney is an important excretory organ of the human body, and the whole body is covered with blood vessels. The whole body blood carries all kinds of metabolic wastes through the kidney, filters out excess water, ions and metabolic wastes, and forms urine discharge, so the kidney is full of blood vessels.

(2) Renal blood vessels will become narrower and narrower under hypertension. When blood pressure is high, these blood vessels will make the blood vessel wall thicker and thicker in order to resist excessive pressure, and the price of this change is to make the blood vessel cavity narrower and narrower.

(3) The narrowing of blood vessels will lead to renal ischemia, which will lead to atrophy after a long time. The blood vessels in the kidney become very thin, which is not only not conducive to the filtration of toxins, but also unable to ensure the basic blood supply of the kidney, leading to ischemic atrophy of the kidney and "withering" of the surface. On the basis of ischemia and hypoxia, the concentration function of urine is impaired, and the number of times patients go to the toilet at night will increase inexplicably. Further deterioration, glomerular permeability increases, the filtration effect is getting worse and worse, and protein, red blood cells and casts can appear in urine.

How can hypertensive patients judge whether there is renal damage? After kidney damage, wastes in the body will gradually accumulate, which may lead to the following five warning signals. If it appears, patients with hypertension must be vigilant.

It should be noted that the process of kidney damage caused by hypertension is very slow. According to the investigation of hypertension patients for 5 years, it was found that only 10% patients had increased serum creatinine (a sign of decreased renal function). For the elderly and patients with systolic blood pressure greater than 160 mmHg, only 2% 5% will develop uremia within 10 ~ 15 years.

Therefore, most hypertensive patients in China did not realize the seriousness of hypertensive renal damage at the early stage of the disease. It is found that renal function is abnormal and even has progressed to uremia. "Ask the doctor" reminds you that the damage of hypertension to the kidney is almost irreversible! Once it happens, there is no cure. We must pay attention to the prevention of kidney damage to the heart.

The so-called hypertensive renal damage, as the name implies, is the damage of renal structure and function caused by hypertension.

This is why, when I just found out that I have high blood pressure, when I went to see a doctor, the doctor often opened a lot of tests. Some patients feel strange, not only high blood pressure, but also need to check so many things! In fact, whether hypertension does harm to the organs of the body needs comprehensive evaluation. Because, in addition to the kidneys, the heart, brain and eyes are also the target organs of hypertension.

At present, the detection of early hypertensive renal damage is mainly achieved by checking sensitive indicators in some laboratories.

Under normal circumstances, albumin in blood cannot pass through the filter barrier of the kidney, so it will not enter the urine. However, hypertension will lead to the change of renal hemodynamics, and the pressure of capillary in glomerulus will increase, which will lead to the increase of renal filtration. Therefore, the early manifestation of hypertensive renal damage is the increase of microalbumin level in urine.

Detection of serum cystatin C This is a blood test. Cystatin C in serum is an enzyme, and kidney is almost the only way to excrete it. Because the metabolism of cystatin C is not affected by muscle, exercise, inflammation and other factors, it is basically only affected by glomerular filtration rate. Generally speaking, serum creatinine and urea nitrogen levels are normal, but cystatin C level is high, which is a typical manifestation of early renal damage, and many elderly people can appear after renal function begins to decline. Serum cystatin C is a very sensitive index to evaluate early hypertensive renal damage.

Detection of urinary α 1- microglobulin and urinary β2- microglobulin Under normal circumstances, these two microglobulins can enter the renal tubule through the glomerulus, but will be reabsorbed at the proximal end of the renal tubule. However, when hypertensive renal damage causes abnormal renal tubular function, the reabsorption of these two microglobulins by renal tubules will decrease, resulting in an increase in their urine levels. In other words, when these two indicators in urine rise, it is likely that renal tubules are damaged.

Color Doppler ultrasound of renal artery Color Doppler ultrasound is also called color Doppler ultrasound blood flow imaging, which can evaluate the blood flow resistance index of renal artery. Studies have shown that renal injury caused by hypertension will first increase the blood flow resistance of renal interlobar artery. Therefore, evaluating the blood flow resistance index of renal interlobar artery by renal artery color Doppler ultrasound can also judge the early hypertensive renal damage.

In addition to the above indicators, there are actually some other indicators with similar values. For example, the ratio of random urinary microalbumin to creatinine and urinary retinol binding protein have similar significance to urinary microalbumin, reflecting the damage of glomerular filtration; The increase of NAG level in urine is similar to that of urinary microglobulin, which reflects the damage of renal tubules.