Nephrogenic arterial hypertension: causes, symptoms, diagnosis, treatment

Increase in blood pressure can signal not only the pathology of the heart and blood vessels, but also other pathological changes in the body. Most changes in renal tissue radically change the work of internal organs, including the work of blood vessels and heart.

Nephrogenic arterial hypertension

Nephrogenic arterial hypertension( secondary hypertension) is a disease in which the level of arterial pressure rises as a consequence of damage to the parenchymal tissue of the kidneys or their vascular system.

Classification of the disease:

1. Vasorenal form( pathology of renal vessels);
2. Parenchymal form( various types of nephropathies, chronic inflammatory interstitial processes);
3. Mixed form.

In the international classification of ICD-10, nephrogenic arterial hypertension has a code I 12

In a video on what is hypertension:

Causes and types of

Causes of secondary nephrogenic hypertension:

1. Vascular factors include a thickening of the fibro-muscular layer of the renal arteries,formation on their inner layer of atherosclerotic plaques, as well as aneurysms( pathological sites of thinning).Such pathologies as aortic coarctation, arteriovenous fistulas( fistulas), displacement of the renal artery with the omission of the kidney contribute to the development of an elevated level of blood pressure in the vascular bed of the patient.
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The cause of increased blood pressure is ischemia of the kidney. If there is a violation of the blood supply of the renal parenchyma, the production of renin increases, which promotes the transformation of angiotensinogen into angiotensin. Angiotensin 1 is transformed into angiotensin 2, which significantly increases the tone of the kidney vessels and vascular resistance at the periphery. Increases the production of aldosterone, which delays the fluid in the human body.

1. If the patient suffers from inflammatory kidney disease or a type of nephropathy, atrophy of the kidney tissue develops. As a result, the volume of blood in the vascular bed increases because of the increased concentration of sodium from the body.

There are such types of nephropathies:

1. Nephropathy on the background of diabetes mellitus. Because of the elevated blood glucose level, biochemical and metabolic disturbances of metabolic processes are noted, which are reflected in the elasticity and strength of the vessel wall and renal parenchyma;
2. Uric acid with gout crystallizes into the tissue of the kidneys, which reduces the number of normal functional units( nephrons);
3. In autoimmune processes and the taking of certain medications, membrane nephropathy may occur, the mechanism of its development is the fixation of immune complexes in the cells of the kidney tissue;
4. Toxic nephropathy arising from exposure to toxic agents;
5. Dismetabolic nephropathy is caused by the deposition of crystals of various substances in the interstitium of the kidneys against the background of metabolic disorders.

Signs and Symptoms of

Arterial hypertension of renal origin most often develops gradually, differs from primary hypertension with a higher level of blood pressure at the time of the heart relaxation phase. Arterial pressure is stable with respect to antihypertensive therapy. Patients complain of headaches, with localization more often in the nape of the neck, thirst, constant fatigue, a decrease in appetite, which is typical of hypertension. In the morning, swelling( mostly on the face - a kidney origin) often occurs, which decrease by evening, with a certain pathology in the urine, in the laboratory examination, a certain amount of protein is detected, exceeding the norm.

Diagnostic methods

The syndrome of nephrogenic arterial hypertension is diagnosed after such studies:

1. To correctly diagnose it is very important to correctly collect an anamnesis of life and disease, to clarify the patient's complaints.
2. The general analysis of urine and blood is mandatory. Based on the results of UAC, an increase in the activity of erythropoietin( the number of erythrocytes above the norm) can be determined. And in the urine can be found leukocytes, which indicates the presence of inflammation in the kidneys.
3. With stenosis of the renal arteries during auscultation in the epigastric region, systolic or systolic-diastolic murmurs are recorded, which are well conducted in the lateral areas. They are clearly heard in the left or right costal-vertebral corners. Systolic murmur is recorded when the site of the renal artery is narrowed, and systolic-diastolic is recorded with an aneurysm( pathological thinning of the wall).
4. The arterial blood pressure level must be measured at rest and after physical exertion, before and after transition from the horizontal position of the body to the vertical one. Fix the difference in arterial pressure on the arms and legs and the asymmetry of the pulse, which is indicative of coarctation( narrowing) of the aorta and aortoarteritis.
5. In case of suspicion of nephrogenic hypertension, the patient should be advised to consult an ophthalmologist. On the fundus there are such changes: edema of the optic nerve, multiple hemorrhages and venous plethora, areas of ischemia. In these patients, visual function is often impaired.
6. Ultrasonography of the kidneys with Doppler. This method allows you to determine the intensity and direction of blood flow in the renal artery, the structure of the kidneys and urinary tract itself.
7. Excretory urography. The method of diagnosis, which allows you to identify the delay in contrasting the kidney and many other changes.
8. Scintigraphy with radioisotope angiography is used, renal angiography with contrasting( method of visualization of vessels with the introduction of contrast medium).During the course of renal angiography it is possible to establish renin activity in the blood, the increase of which is considered a reliable sign of this disease.

MRI and CT studies are widely used to diagnose the state of the renal vascular system and their interstitial tissue.

Treatment of

Arterial hypertension of renal origin has in most cases a malignant course. In order to prevent the emergence of severe consequences of therapy should be prescribed in the early stages of the disease.

1. The vasorenal form of hypertension is treatable by invasive interventions. If the lumen of the renal artery is narrowed, the blood supply to the parenchyma is impaired. By installing a balloon catheter or special stent inside the artery at the site of its stenosis, you can restore normal blood flow.

Open operations for artery reconstruction are also applied: resection of the narrowed area with the application of anastomosis, endarterectomy, installation of an arterial prosthesis.

When nephroptosis is used, interventions for nephropexy( fixation).The lack of functional activity of the kidney is an indication for the removal of the kidney.

1. Treatment of the parenchymal form of arterial hypertension should be aimed at eliminating the cause and the primary pathological process in the human body.

There are such medical methods of treatment for various forms of nephropathies:

• If the cause of hypertensive syndrome was chronic pyelonephritis, the goal of the therapy is to eliminate the bacterial factor and restore the free flow of urine. Appointed depending on the causative agent of the disease, a certain antibacterial drug( antibiotics of the penicillin series, cephalosporins, carbapenems, monobactams, aminoglycosides, tetracyclines).Non-steroidal anti-inflammatory drugs are also used.

Trental( pentoxifylline) is prescribed to improve the elasticity of red blood cells. This drug reduces the aggregation capacity of platelets, thereby improving blood flow in the vascular bed. With the same purpose, appoint Venoruton( troxevasin) for 3-4 weeks.

• In the case of the formation of arterial hypertension in the background of various nephropathies, the cause of their development should be eliminated: with diabetic or dismetabolic nephropathy, it is recommended to observe a low-protein diet, normalize the balance of lipids in the body. Assigning ACE inhibitors( lisinopril, captopril, berlipril, prestarium).
• Gouty nephropathy is treated by the appointment of allopurinol, which promotes the dissolution of uric acid crystals and reduces their formation. Patients should adhere to a diet regime with a low content of purines.
• In order to reduce high blood pressure, angiotensin 2 receptor blockers( valsartan, losartan).
• For the improvement of the immunological properties of the body, various adaptogens( magnolia vinegar Chinese, ginseng), methyluracil 4 g per day for several weeks are prescribed.
• As immunomodulators in the long-term inflammatory process of the autoimmune character, levamisole, thymalin, and T-activin are used. They reduce the response of the body's immune system.

1. Use ground flax seeds inside before eating;
2. A mixture of crushed berries of cranberries with honey, take every day;
3. Pre-washed pine cones are poured with alcohol 40% and infused in a dark place for 3-4 weeks.

Prognosis and complications

The prognosis regarding the life and ability to work of a patient suffering from hypertension of renal genesis is rather favorable in the event that the primary disease was detected at early stages of development and certain therapeutic measures were set in time.

Positive dynamics is noted in patients who underwent surgery. If both kidneys are affected, the forecast is unfavorable.

Possible complications: heart and vascular insufficiency, myocardial hypoxia and ischemia, strokes, development of renal failure.