Renal arterial hypertension: treatment and symptoms
High blood pressure is a major problem of the century, because blood pressure reflects the functional capabilities of the heart and blood vascular. Renal hypertension (hypertension) is called arterial hypertension, having a pathogenetic relationship with renal insufficiency. The disease belongs to the secondary type of hypertension.
Pathology is found in 10-30% of all diagnosed cases of hypertension.
In addition to high blood pressure (140/90 mm Hg. art. and above), syndrome renal arterial hypertension is accompanied by characteristic symptoms are: sustained increase in diastolic blood pressure, young age of patients, high probability of a malignant form of the disease, poor efficacy of drug therapy, the negative forecasts.
Vascular form is 30% of all cases of rapidly progressive diseases, 20% of the conservative treatment is ineffective.
Types of nephrogenic hypertension:
- Parenchymal PG occurs in diseases associated with damage of renal tissue. At risk for renal hypertension - patients with pyelo and glomerulonephritis, diabetes, polycystic kidney disease, tuberculosis, nephropathy pregnant.
- Renovascular (renovascular) hypertension caused by high blood pressure associated with changes in arteries in atherosclerosis, malformations of the vascular system, thrombosis and aneurysm. This form of PG common in children (90% under 10 years), in elderly patients the proportion of renovascular PG is 55%.
- Combined form of PG involves a combination of parenchymal lesions of the kidney with blood. Diagnosed in patients with nephroptosis, tumors and cysts, congenital kidney problems and abnormal blood vascular.
The mechanism of the disease
Nephrogenic hypertension manifested a steady increase in AD-related problems of the urinary system. Every third patient with high blood pressure has a kidney problems. With age, the percentage of probability of disease increases.
The main function of the kidneys is filtering the blood with the output of sodium and water. The mechanism is understood from high school physics: pressure of filtration created by the difference in cross section of blood vascular that bring blood and those who endure. Clean blood back into the arterial system.
Trigger hook, ensuring the start of GHGs is the reduction of blood supply to the kidneys. Accumulate excess fluid, edema. Sodium causes an increase in blood vascular, increasing their susceptibility to a narrowing vessel components (aldosterone,angiotensin).
At the same time aktiviziruyutsya RAAS (renin-angiotensin-aldosterone system). Renin, secreted to break down proteins, independently of the pressure does not increase, but along with protein synthesizes angiotensin under which aktiviziruyutsya and aldosterone, leading to accumulation of sodium.
In parallel with the production of substances that trigger the growth of AD decreases the amount of prostaglandins that contribute to its decrease.
All these disorders affect the normal functioning of the heart and blood vascular. PG is often accompanied by serious complications causing disability, and even death.
Causes of PG
Causes of increased renal pressure are of two types.
- dysplasia, hypoplasia, thrombosis, and embolism;
- arteriovenous fistula of the kidney;
- injury vascular;
- anomalies of the aorta and divisions of the urinary system.
- atherosclerosis of the arteries;
- arteriovenous fistula;
- squeezed a tumor, hematoma or cyst arteries.
The pathogenesis of PG to be fully explored. In many cases it is associated with stenosis of the arteries, this is especially true for patients older than 50 years.
Symptoms of the disease
The formation of the symptoms of hypertension and the underlying disease of the kidneys. The manifestation of symptoms depends on the form of the disease: benign develops gradually, malignant - rapidly.
The first variant is characterized by stability HELL with a predominant increase in diastolic pressure. Complaints of shortness of breath, fatigue, discomfort in the heart.
The second variant is characterized by increased pressure, a sharp weakening of view (up to its complete loss). This is due to poor circulation in the retina. Complaints of acute headache, accompanied by vomiting and dizziness.
Typical disease symptoms are similar to symptoms of hypertension, tachycardia, dizziness and headaches, panic attacks, decrease of brain activity (memory problems, decreased concentration).
Renal hypertension usually manifests itself against the background of kidney damage in some diseases (pyelonephritis, diabetes mellitus, glomerulonephritis), so her symptoms are always associated with underlying illness.
Among the common complaints:
- pain in the lumbar-sacral region of the spine;
- frequent urge to urinate;
- doubling the daily requirement of urine;
- intermittent fever;
- fatigue, General malaise.
The disease begins suddenly,the increase in pressure is accompanied by pain in the lumbar. The tendency of PG can be inherited from parents-hypertensives. Conventional drugs for lowering pressure, in such situations, do not work.
The clinical picture of PG depends on the degree of change in AD, the initial state of the kidneys, complications (heart failure, infarction, lesions of the retina and blood vascular of the brain).
Diagnosis of renal hypertension
The disease is diagnosed by laboratory methods, urography, radioisotope renography, a kidney biopsy.
In the primary treatment prescribed a General survey. Among the obligatory studies urine and blood samples from the veins of the kidney to identify the enzyme, provoking the increase in blood pressure.
The test results show that choosing an optimal regimen, including the need for surgical intervention.
For a detailed study of the causes and extent of organ damage ultrasound carried out (data on the size and structure of the kidneys, possible tumors, cysts, signs of inflammation), in cases of suspected malignant changes prescribed an MRI.
Symptom wasreally PG when listening to the area above the navel - systolic murmur, radiating back to the spine and sides of the abdomen. Controlled by changing the pattern of blood vascular of the eye (the retina swells, the vascular are already rules, there are hemorrhages. Drops vision. Diagnosis of kidney failure is a very important stage of therapy. A real help to the patient is possible only after identifying all the reasons for the increase in BP.
Methods of treatment of nephrogenic hypertension
Drug treatment of renal hypertension is aimed at restoring normal blood pressure with parallel treatment of the underlying disease. Symptoms of renal hypertension indicate the presence of complications caused by some disturbances. For stabilization AD used:
- Tiazidove diuretics and blockers. Treatment is long and continuous, following diet restricting the amount of salt consumed. The degree of manifestation of renal failure, estimated the size of glomerular filtration, which must be considered when designing treatment regimens.
- Renal function strengthen antihypertensives. In secondary PG most effective dopegit and prazosin protecting the organs to restore their normal functioning.
- In the terminal phase of PG require hemodialysis, in between the procedure prescribed antihypertensive treatment. The course contains and means to strengthen the immune defense.
Renal hypertension rapidly progressive, disabling not only the kidneys but also the brain, the heart, so it is important to start treatment immediately after diagnosis.
The lack of effectiveness of drug therapy, if you experience cysts and other anomalies recommend operative and invasive treatment, such as balloon angioplasty.
Dilation of blood vascular, inflating the balloon with a catheter that is inserted into the artery. Along with a microdenture in this way protect the vessel from further contraction.
Surgical techniques are indicated for preservation of renal function. Prescribed for severe stenosis, blocked the Lumina of the arteries, the lack of effectiveness of angioplasty. If you want to hold nephrectomy. In further need of a kidney transplant.
Prevention of renal hypertension
Prevention of illness is not only aimed at the normalization of HELL, but also to prevent the development of renal pathology. In chronic diseases recommend supplements in the operating state of the internal organs and to restore normal metabolism.
In the treatment of folk remedies need to be particularly careful. Some of the "popular" recipes can provoke a wave of exacerbations of the disease.
Patients with renal insufficiency it is important to carefully control the symptoms of renal hypertension, avoid inappropriate workloads and hypothermia. Methods of modern medicine allow us to keep AD in good condition.