The relationship between the vascular and urinary system is obvious: the kidneys filter blood, stabilizing the level of viscosity, the heart provides the blood flow needed by the kidney glomeruli. Diseases of the cardiovascular system sooner or later lead to functional disorders of the kidneys, and somatic kidney diseases - to vascular lesions. Hypertensive nephropathy is an excellent example of how high blood pressure negatively affects the work of the body's main filter - the kidneys.
Hypertensive nephropathy - what is it?
Hypertonic nephropathy is a renal disease of vascular origin. To make this diagnosis, it is extremely important that it is hypertension that was the cause of nephropathy, and not vice versa.
Given the prevalence of hypertension and the unavoidable prognosis of kidney failure with elevated blood pressure, the problem can be called quite serious and requires attention, timely diagnosis and adequate treatment.
In the international classification of ICD-10, hypertensive nephropathy has the code I12.0( with kidney damage with renal insufficiency) and code I12.9( with kidney damage without renal failure).
Reasons for
Hypertension is the primary cause of hypertensive nephropathy. Its genesis does not matter, with one exception: hypertension, triggered by increased renin production.
That is, considering the causes of hypertensive nephropathy, it is important to consider the causes of hypertension itself. In most cases, we are talking about atherosclerosis, that is - high cholesterol in the blood and the subsequent formation of plaques on the inner walls of the vessels.
The development of hypertensive nephropathy is not the last effect of edema, for example, against a background of a decreased function of the thyroid gland. Extra fluid in the body increases the total volume of blood, because the pressure rises according to the laws of physics. Then there are changes in the vascular tissues due to the high stress, disruption in the kidneys, and hypertension becomes permanent, that is, it is almost impossible to get rid of it simply by eliminating swelling.
Progression of hypertensive nephropathy usually proceeds gradually, but sometimes the reason for its appearance becomes hypertensive crisis. When the pressure rises sharply, the kidneys are heavily loaded, the glomerular membranes are perforated, the filtration capacity of the organs falls.
Pathogenesis
Hypertensive nephropathy can be divided into four stages of development:
- The first stage is the debut of the disease, that is, the condition in which there is no symptomatology, and the deviations in the analyzes are so insignificant that they can be overlooked or not given importance to them. At this stage, the patient is in good health.
- The second stage is an isolated stage of the disease, when changes in the analyzes can be detected against the background of the absent symptomatology. Often pathology "produces" proteinuria - traces of protein in the urine. Less commonly, urine can detect altered blood cells - red blood cells.
- In the third stage, the symptomatology focuses on the activity of the cardiovascular system: the pressure is stably higher than the physiological norm, it can not be normalized with the help of medications for a short while, so a person is forced to constantly take medications. Deviations in the analyzes showing the activity of the kidneys remain, and even the progress of the deviation from the norm of many indicators is noted. But while the main marker of kidney filtration efficiency - the rate of blood filtration by glomeruli( GFR) remains within normal limits, a person does not feel any signals of changes in the functioning of the urinary system.
- In the fourth and last stage of hypertensive nephropathy, vascular lesions and renal manifestations are equally pronounced. Blood pressure increases, GFR decreases, a person constantly struggles with unimportant well-being. Drugs for pressure reduction, selected independently, without the supervision of a doctor, are ineffective, so the burden on the kidneys increases and the picture of symptoms is supplemented by signs of kidney failure.
Clinical picture of
Symptomatic of hypertensive nephropathy becomes evident with the third stage of the disease. It includes the symptoms of a violation of the filtration of the urinary system and signals about the sclerosis of the vessels:
- nocturnal diuresis - a marker of a violation of the concentration ability of the kidneys;
- edema - a falling level of GFR is not able to provide not only the purification of blood from decay products, but also to remove all excess fluid;
- protein in urine - this symptom can sometimes be seen without resorting to a laboratory test: urine with protein strongly foams;
- bad breath and taste of iron on the tongue - symptoms of kidney failure and intoxication;
- high blood pressure - with existing nephropathy, this symptom is equally a consequence of both poor kidney function and the pathology of the vascular system;
- reduced overall tone - is a consequence of all the factors described above.
There is a tendency to accelerate the manifestation of symptoms of the disease during the flow from one stage to another. In other words, the debut stage or the isolated urinary syndrome can last for years, but the 3rd and 4th stages develop much faster, so the sclerized vessels contribute to a faster lowering of the SFC.In this case, the lack of kidneys, in turn, affects the vessels because of the increased amount of fluid in the bloodstream, lipid metabolism disorders.
Diagnosis
When collecting an anamnesis to a doctor, you need to make sure that hypertension acts as the root cause of the ailment, and is not a consequence of kidney disease. To this end, previously obtained laboratory and functional studies are studied, the data on the genetic factor are elucidated, and clinical signs are analyzed.
Laboratory diagnostics is aimed, first of all, at revealing the stage of kidney disease. For this purpose,
- is assigned a complete urine analysis for protein detection, density reduction, erythrocyturia;
- Zimnitsky's test to assess the ability of organs to concentrate urine;
- Reberg's test for the determination of GFR;
- lipidogram;
- blood test to determine the level of urea, potassium, creatinine.
Assignment and functional examination methods:
- angiography of vessels for establishing the fact of atherosclerosis and its degree;
- MRI, CT to diagnose the extent of renal tissue damage;
- renography with Hippuranum to determine the function of both kidneys separately from each other;
- X-ray with contrast for visualization of patency of arteries and vessels.
In addition, you need data on the level of blood pressure. To do this, the patient is asked to take measurements in the morning and evening, recording the indicators in a special table, or go through a daily monitoring of the pressure.
Treatment of
In stages 1 and 2 of hypertensive nephropathy, when the function of the kidneys is still maintained, the emphasis of therapy is on normalizing the indices of pressure. To do this, use drugs: diuretics, removing excess fluid from the body and ACE inhibitors.
The administration of drugs for the correction of high blood pressure should be constant, it is optimal to take a small dose of the drug every day than to fight the pressure on the fact of its increase by a high dosage.
During the first two stages, a therapeutic effect can be achieved with a diet with a limited amount of sodium.
In the third and fourth stage, hospitalization in the hospital, in the nephrologic or therapeutic department is required. The prevailing task of the therapy will be to lower the pressure and eliminate puffiness, as well as control over the work of the kidneys. After discharge, the patient continues to be treated on an outpatient basis, regularly taking tests.
Regardless of the stage of hypertensive nephropathy, the patient should keep a record of his pressure daily, morning and evening. This will determine the appropriate dosage of the drug and the time it is taken.
Forecasts and complications of
At 1 and 2 stages of the disease, the prognosis is usually favorable. The kidneys retained their function, and the control over arterial pressure will allow them to work in a comfortable mode.
In the last stages the prognosis is moderately favorable provided that the doctor is constantly monitored and his appointments are performed. Otherwise, the risk of complications is high:
- renal failure and renal insufficiency;
- infarction;
- stroke;
- uremia;
- internal hemorrhage.
Among other things, advanced hypertensive nephropathy requires the reception of a considerable amount of drugs that negatively affect the tissues and activity of the liver and stomach.
On the video about the causes, symptoms and diagnosis of hypertensive nephropathy: