Renal hypertension is accompanied by a prolonged increase in blood pressure, which is due to a violation of the kidneys. This type of disease is secondary and is diagnosed in every tenth patient with high blood pressure.
A characteristic sign of pathology is a prolonged increase in the symptom, which in medicine is called renal pressure. This condition usually occurs in people at a young age. Treatment of renal hypertension and its effectiveness will depend on the correctness of the diagnosis.
Read in this article
What is the danger of the disease
The described ailment not only causes suffering to patients and worsens the quality of life, but is also dangerous with the possibility of serious pathological 
phenomena like:
Decreased vision, up to blindness;
Development of cardiac and renal pathologies;
Severe damage to the arteries;
Pathological changes in the composition of the blood;
The occurrence of atherosclerosis of the vessels;
Problems with lipid metabolism;
Disorders of cerebral blood supply.
The disease negatively affects a person's performance, leads to disability, which often ends fatally.
Renal hypertension, the treatment of which depends on the symptoms, manifests itself as a stable hypertensive syndrome. Often the process turns into oncology. The disease can be expressed as the main symptom of nephropathy. Clinical manifestations of the underlying disease can be expressed in conjunction with symptoms of other diseases.
With the development of hypertension of renal etiology, patients complain of weakness, often get tired.
Diagnosis of pathology
In order to establish the correct diagnosis and prescribe an effective therapeutic approach to the patient, a comprehensive study of the whole organism should be carried out using laboratory and instrumental techniques.
Hypertension is diagnosed if a person's blood pressure values are above 140/90 for several weeks. However, urinalysis can detect problems at an early stage of development. When additional diseases of the excretory system are detected, the renal form of the disease is diagnosed, which is considered secondary.
Laboratory blood and urine tests represent one of the most important diagnostic steps. Ultrasound examination helps to determine the presence of physiological changes in the kidneys and other disorders.
Patients also undergo scanning, urography and radiography.
MSCT: stenosis of the right renal artery (arrow) in a patient with vasorenal hypertension With the help of combined methods, it is possible to determine the type of disease, after which it is worth starting treatment tactics.
Medical tactics
Therapy of the disease is aimed at resolving two main tasks: the resumption 
kidney functionality, restoration of blood supply and reduction of blood pressure.
For this purpose, drugs are used to treat renal hypertension, as well as special hardware and surgical techniques.
Therapeutic tactics are aimed at curing the main disease. The conservative method involves the appointment of pharmaceuticals that affect the mechanism of the appearance of arterial hypertension. One of the main principles is therapy with a minimum number of side effects.
A sample list of pills for the treatment of renal hypertension consists of diuretics, beta-blockers, as well as many other drugs prescribed by the attending physician.
Hardware methods
One of the innovative and effective therapeutic methods is phonation. It involves the installation of special devices on the human body that help restore kidney functionality, increase the production of uric acid, and restore blood pressure.
Phonation of the kidneys with the apparatus "Vitafon" at home Surgery
Surgical therapy for a disease such as renal hypertension is due to individual characteristics (for example, doubling of an organ or the formation of cysts on it).
Add onion and garlic to food;
Drink freshly squeezed juices;
Being one of the clinical manifestations of a whole list of diseases, nephrogenic hypertension helps to diagnose serious diseases. You should not drink medicines to treat renal hypertension on your own. Only timely and effective treatment gives a person every chance for a successful recovery.
Read also
Modern, newest and best drugs for the treatment of hypertension allow you to control your condition with the least consequences. What drugs of choice do doctors prescribe?
Hypertonic disease(synonyms: primary, or essential, idiopathic hypertension) is a chronic disease, the main clinical sign of which is a long-term and persistent increase in blood pressure (hypertension).
Relevance of the problem
There is still no consensus on which indicators of blood pressure (BP) should be considered as manifestations of hypertension. However, most reputable experts are unanimous that long-term retention of blood pressure at a level of more than 160/95 mm. Hg defined as hypertension.
Hypertension etiology may be classified respectively:
"primary" (idiopathic)- the cause is unknown;
"secondary" or symptomatic hypertension, which is a manifestation of many diseases of the nervous, endocrine systems, pathology of the kidneys and blood vessels.
Hypertension (hypertension) is the most common cause of high morbidity and mortality worldwide. Most cases of hypertension are classified as “primary”, but it must be remembered that the cause may not be identified due to insufficient examination of the patient. It is generally accepted that hypertension, like atherosclerosis, is a disease of urbanization and is widespread in economically developed countries experiencing ever-increasing stress in the psycho-emotional sphere. Hypertension is called the “disease of unreacted emotions”. In an epidemiological study of the African continent, as well as in some areas located in the eastern Pacific Ocean, an unusually low mean blood pressure was noted among the inhabitants. However, in East and North Africa, a high incidence of hypertension with a tendency to progression has been registered. Many epidemiological data show a positive correlation between weight and both systolic and diastolic blood pressure. This association is especially strong in young people, but decreases in older people. It is noted that in hypertensive patients who lose weight, blood pressure decreases. It is hypothesized that high blood pressure is inherited, however, exact data is not given. The blood pressure of patients and their immediate children is dependent, while this dependence is not observed in parents and adopted children. The correlation of blood pressure in homozygous twins is high, while in heterozygous twins it is low.
Pathogenesis. There is currently no generally accepted theory of the origin and development of hypertension. A key feature of persistent primary hypertension is an increase in peripheral vascular resistance. Numerous thorough clinical and physiological studies indicate that there are many mechanisms leading to the development of primary hypertension. Of these, three main pathophysiological mechanisms are currently accepted and include:
sodium homeostasis;
sympathetic nervous system;
renin-angiotensin-aldosterone system.
sodium homeostasis. It is noted that the first detectable changes are delayed renal excretion of sodium. Sodium retention is accompanied by an increase in the volume and velocity of blood flow due to an increase in cardiac output. Peripheral autoregulation increases vascular resistance and eventually causes hypertension. In patients with primary hypertension, Na + -K + -transport is changed in all blood cells. In addition, the blood plasma of hypertensive patients, when transfused, can damage Na + -K + -transport in the blood cells of healthy people. This indicates the presence in patients (with reduced sodium excretion) of substances circulating in the blood that inhibit Na + -transport in the kidneys and other organs. The overall level of Na + in the body positively correlates with BP in hypertensive patients and does not correlate in the studied normotonic patients (control group). In most healthy adults, minor changes in blood pressure are detected, depending on the intake of salt with food. Some hypertensive patients are classified as "primary saline", but the nature of the changes underlying hypertension in these patients is unknown. It is known that an increased transition of Na + into the endothelial cells of the arterial wall can also increase the intracellular content of Ca 2+ . This contributes to an increase in vascular tone and hence, consequently, peripheral vascular resistance.
Sympathetic nervous system. Blood pressure is the derivative of total peripheral vascular resistance and cardiac output. Both of these indicators are under the control of the sympathetic nervous system. It was found that the level of catecholamines in blood plasma in patients with primary hypertension is increased compared to the control group. The level of circulating catecholamines is very variable and can change with age, intake of Na + in the body, in connection with the state and physical activity. In addition, it was found that in patients with primary hypertension there is a tendency to a higher content of norepinephrine in plasma than in young people in the control group with normal blood pressure.
Renin-angiotensin-aldosterone system. Renin is formed in the juxtaglomerular apparatus of the kidneys and diffuses into the blood through the “efferent arterioles”. Renin activates a plasma globulin (called "renin substrate" or angiotensin) to release angiotensin I. Angiotensin I is converted to angiotensin II by angiotensin transferase. Angiotensin II is a powerful vasoconstrictor and therefore its elevated concentration is accompanied by severe hypertension. However, only a small number of patients with primary hypertension have elevated plasma renin levels, so there is no simple direct relationship between plasma renin activity and the pathogenesis of hypertension. There is evidence that angiotensin can stimulate the sympathetic nervous system centrally. Many patients respond to treatment with angiotensin transferase inhibitors such as catopril, enalapril, which inhibit the enzymatic conversion of angiotensin I to angiotensin II. Several therapeutic experiments have shown that angiotensin transferase inhibitors given shortly after acute myocardial infarction reduce mortality, presumably by reducing myocardial dilatation.
Recently, associations have been found between mutations in the genes encoding the production of angiotensin I, angiotensin transferase, and some angiotensin II receptors and the development of primary hypertension. A connection has also been established between the polymorphism of the gene encoding the production of angiotensin transferase and “idiopathic” cardiac hypertrophy in patients with normal blood pressure. At the same time, the exact mechanism of changes in the structure of genes is still unknown.
Pathological anatomy. Morphological manifestations of hypertension depend on the nature and duration of its course. According to the nature of the course, the disease can proceed malignantly (malignant hypertension) and benign (benign hypertension).
At malignant hypertension manifestations of a hypertensive crisis dominate, i.e., a sharp increase in blood pressure due to spasm of arterioles. Morphological manifestations of hypertensive crisis:
corrugation and destruction basement membrane, the location of the endothelium in the form of a palisade as a result spasm of arterioles;
plasma impregnation or fibrinoid necrosis its walls;
thrombosis, sludge phenomenon.
With this form, heart attacks and hemorrhages often develop. Currently, malignant hypertension is rare, benign and slowly flowing hypertension predominates.
At benign form of hypertension There are three stages that have certain morphological differences:
preclinical;
pronounced widespread morphological changes in arterioles and arteries;
secondary changes in internal organs due to changes in blood vessels and impaired intraorgan circulation.
At the same time, at any stage of benign hypertension, a hypertensive crisis with its characteristic morphological manifestations can occur.
Preclinical stage of hypertension characterized by a periodic, temporary increase in blood pressure (transient hypertension). Microscopic examination revealed moderate hypertrophy of the muscle layer and elastic structures arterioles and small arteries, spasm of arterioles. In cases of hypertensive crisis, corrugation and destruction basement membrane of the endothelium with the arrangement of endothelial cells in the form of a palisade. Clinically and morphologically, moderate hypertrophy of the left ventricle of the heart.
The stage of pronounced widespread morphological changes in arterioles and arteries is the result of a prolonged increase in blood pressure. At this stage, morphological changes occur in arterioles, arteries of the elastic, muscular-elastic and muscular types, as well as in the heart.
The most characteristic sign of hypertension is changes in arterioles. found in arterioles plasma impregnation, which ends arteriolosclerosis and hyalinosis.
Plasma impregnation arterioles and small arteries develops in connection with hypoxia caused by vasospasm, which entails damage to endothelial cells, basement membrane, muscle cells and fibrous structures of the wall. Later, plasma proteins condense and turn into hyaline. Arteriole hyalinosis or arteriolosclerosis develops. Most often, arterioles and small arteries of the kidneys, brain, pancreas, intestines, retina, adrenal glands undergo plasma impregnation and hyalinosis.
Elastosis and elastofibrosis are detected in the arteries of the elastic, musculo-elastic and muscular types. Elastosis and elastofibrosis- these are successive stages of the process and represent hyperplasia and splitting of the internal elastic membrane, which develops in response to a persistent increase in blood pressure. In the future, the death of elastic fibers and their replacement by collagen fibers, i.e. sclerosis. The wall of the vessels thickens, the lumen is narrowed, which leads to the development of chronic ischemia in the organs. Changes in arterioles and arteries of musculo-elastic and muscular types create the preconditions for the development of the third stage of hypertension. At this stage, the mass of the heart reaches 900–1000 g, and the wall thickness of the left ventricle is 2–3 cm. diffuse small-focal cardiosclerosis.
The last stage of hypertension or the stage of secondary changes in internal organs is due to changes in blood vessels and impaired intraorgan circulation.
These secondary changes can manifest either very quickly as a result of spasm, thrombosis, fibrinoid necrosis of the vessel wall and culminate in hemorrhages or infarctions, or they can develop slowly as a result of hyalinosis and arteriolosclerosis and lead to parenchymal atrophy and organ sclerosis.
Based on the predominance of vascular, hemorrhagic, necrotic and sclerotic changes in the heart, brain, kidneys, patients with hypertension are isolated cardiac, cerebral and renal clinical and morphological forms.
The cardiac form of hypertension, together with the cardiac form of atherosclerosis, constitute the essence of coronary heart disease (see "Ischemic heart disease").
The cerebral form of hypertension is discussed in the section on cerebrovascular diseases.
Renal form of hypertension characterized by both acute and chronic changes.
Acute changes include renal infarcts and renal arteriolonecrosis, which are associated with thromboembolism or arterial thrombosis. Arteriolonecrosis of the kidneys is morphological manifestation of malignant hypertension. In addition to arterioles, capillary loops of the glomeruli undergo fibrinoid necrosis, edema and hemorrhages occur in the stroma, and protein degeneration occurs in the epithelium of the tubules. In response to necrosis in arterioles, glomeruli and stroma, a cellular reaction and sclerosis develop. The buds look somewhat reduced in size, variegated, their surface is finely granular. Arteriolonecrosis leads to acute renal failure and is usually fatal.
The most characteristic changes are detected in the kidneys in the benign course of hypertension. These changes are due to malnutrition, i.e. chronic ischemia. As a result of insufficient blood supply and hypoxia, the tubular part of most nephrons atrophies and is replaced by connective tissue, which also grows around dead glomeruli. Small multiple foci of retraction appear on the surface of the kidneys. Nephrons corresponding to relatively intact glomeruli hypertrophy and protrude above the renal surface. The kidneys are sharply reduced in size (almost twice), dense, their surface is fine-grained, the parenchyma is evenly thinned, especially the cortical substance. The mass of the kidneys can reach 50-60 grams. Such kidneys are called primary wrinkled. Primarily, because the decrease in the kidneys occurs from normal sizes, while in all other cases (with inflammation, dystrophic processes), the kidneys first increase in volume, and then they decrease again. Another name for the kidneys “arteriolo-sclerotic nephrosclerosis” shows that the disease is initially based on damage to arterioles. Patients most often die with this form from chronic renal failure (azotemic uremia).
Eye changes in hypertension, they are secondary and are associated with typical vascular changes. These changes are manifested in the form of edema of the optic nerve papilla, hemorrhages, retinal detachment, in severe cases, its necrosis and severe dystrophic changes in the nerve cells of the ganglionic layer.
Causes of death. The most common causes of death are heart failure as a result of diffuse cardiosclerosis (in acute cases - myocardial infarction), chronic renal failure (azotemic uremia), cerebral hemorrhage.
- What are the features of the disease?
Renal hypertension is a disease in which blood pressure rises due to kidney disease. Stenosis is characteristic of renal pathology. With stenosis, the main and internal renal arteries and their branches narrow.
Renal arterial hypertension is diagnosed in 10% of patients with high blood pressure. It is characteristic of nephrosclerosis, pyelonephritis, glomerulonephritis, and other renal diseases. Most often it affects men aged 30 to 50 years.
Renal hypertension is a secondary arterial hypertension that occurs as a manifestation of other diseases. The causes of the disease are explained by the disruption of the kidneys and their participation in hematopoiesis. With such a health disorder, it is required to treat the underlying disease, with successful therapy, the pressure returns to normal.
The cause of renal arterial hypertension is damage to the renal tissue, while the renal arteries narrow. Due to impaired kidney function, the volume of circulating blood increases, water is retained in the body. This causes an increase in blood pressure. There is an increased content of sodium in the body due to a failure in its excretion.
Special sensitive formations in the kidneys that perceive stimuli and transmit them to the nervous system, receptors that respond to various changes in the movement of blood through the vessels (hemodynamics), are irritated. There is a release of the hormone renin, it activates substances that can increase the peripheral resistance of blood vessels. This causes an abundant release of hormones from the adrenal cortex, sodium and water retention occurs. The tone of the renal vessels increases, their sclerosis occurs: soft deposits accumulate in the form of a slurry, from which plaques are formed that limit the lumen and affect the permeability of blood to the heart. There is a violation of blood circulation. Kidney receptors are irritated again. Renal hypertension may be accompanied by hypertrophy (excessive enlargement) of the left heart ventricle. The disease mainly affects the elderly, it can occur in young men, because they, in comparison with women, have more body weight, therefore, the vascular bed in which the blood circulates is also larger.
Back to index
What is dangerous hypertension of the kidneys and how can it be determined?
Renal hypertension is dangerous complications. They may be:
- retinal hemorrhage with reduced vision up to blindness;
- heart or kidney failure;
- serious damage to the arteries;
- changes in the properties of the blood;
- vascular atherosclerosis;
- lipid metabolism disorder;
- cerebrovascular disorders.
Such disorders often become the causes of disability, disability, death.
Clinical signs of the disease that may occur in patients:
- systolic or diastolic murmurs heard in the area of the renal arteries;
- heartbeat;
- headache;
- violation of nitrogen excretion function;
- a small amount of protein in the urine;
- decrease in the specific gravity of urine;
- asymmetry of blood pressure in the extremities.
Renal hypertension, the symptoms of which are stable hypertensive syndrome with predominantly increased diastolic pressure, may be malignant in 30% of cases. Arterial hypertension may be the main symptom of nephropathy. The association of hypertension with severe nephrotic syndrome is typical for the development of subacute glomerulonephritis. Malignant hypertension affects patients suffering from periarteritis nodosa, with symptoms of impaired renal function combined with clinical signs of other diseases. In most cases, the pathology of the kidneys is expressed by vasculitis of the intrarenal arteries with an average caliber, ischemia and renal infarction develop.
With hypertension of renal genesis, patients express complaints about fatigue, irritability. There is damage to the retina of the eyeball (retinopathy) with foci of hemorrhage, swelling of the optic nerve head, impaired vascular permeability (plasmorrhagia). To make an accurate diagnosis, instrumental and laboratory diagnostics, studies of the heart, lungs, kidneys, urinary tract, aorta, renal arteries, and adrenal glands are used. Patients are tested for the presence of adrenaline, norepinephrine, sodium, and potassium in the blood and urine. An important role belongs to radioisotropic and X-ray methods. If a lesion of the renal arteries is suspected, angiography is performed, which establishes the nature of the pathology that caused the stenosis of the arteries.
Back to index
How to treat renal hypertension?
Kidney disease is a common cause of high blood pressure. Therapy of hypertension of renal genesis is carried out by cardiologists and nephrologists. Preservation of kidney function is the main goal of therapy. Adequate control of blood pressure is carried out, therapeutic measures are aimed at slowing down the development of chronic renal failure, increasing life expectancy. If nephrogenic hypertension is detected or this diagnosis is suspected, patients are referred to a hospital for clarification of the diagnosis and treatment. In an outpatient setting, preoperative preparation is carried out according to the doctor's indications.
Treatment of renal hypertension combines conservative and surgical methods, antihypertensive and pathogenetic therapy of the underlying disease. Most widely, with a conservative approach, drugs are used that affect the pathogenetic mechanisms of the development of arterial hypertension, reducing the risk of disease progression, do not reduce renal blood supply, do not inhibit kidney function, do not disrupt metabolism, and develop minimal side effects.
A progressive method is often used - phonation of the kidneys. Treatment is carried out by means of a vibroacoustic apparatus, microvibrations of sound frequencies, applying vibraphones to the body. Sound microvibrations are natural for the human body, have a beneficial effect on the functions of systems, individual organs. This technique is able to restore kidney function, increase the amount of uric acid secreted by the kidneys, and normalize blood pressure.
In the process of therapy, a diet is prescribed, its features are determined by the nature of kidney damage. General recommendations include limiting salt and fluid intake. Smoked meats, hot sauce, cheese, strong broth, alcohol, coffee are excluded from the diet. In some cases, surgical intervention is performed according to vital indications. One of the methods for correcting nephrogenic hypertension is nephrectomy (removal of the kidney). With the help of surgery, most patients get rid of nephrogenic hypertension, in 40% of patients the dosage of antihypertensive drugs used is reduced. Increased life expectancy, control of arterial hypertension, protection of kidney function are important outcomes of surgical intervention.
Timely effective therapy of renal hypertension is the key to a quick and successful remission.
When a doctor first diagnoses arterial hypertension or hypertension, the question always arises - why did hypertension develop, what are its causes. In the vast majority of cases, arterial hypertension is essential, that is, a primary, independent disease with many causative factors that requires constant treatment. Much less commonly, kidney disease, such as nephritis, is the cause of hypertension. However, even primary (essential) hypertension involves the kidneys in the process of disease, which, at the same time, suffer from hypertension and maintain high blood pressure numbers.
In terms of their structure, the kidneys are represented by a tangle of small vessels surrounded and penetrated by highly organized renal tissue. The kidneys perform several vital functions in the body, and disruption of these organs causes serious problems for human health and life. Kidney function is directly dependent on blood pressure. If we are dealing with long-term untreated hypertension, then the detection of kidney damage in this case is almost inevitable.
There is a third variant of the relationship between renal disease and arterial hypertension. There may be two diseases - hypertension and kidney disease, which occur separately, for different reasons, but over time reinforce each other. This effect of hypertension also explains the fact that some of the drugs used to treat arterial hypertension help to stop the worsening of kidney disease, sometimes significantly changing the prognosis for the patient in a favorable direction.
Hypertension and kidney disease
Let us dwell on the second variant of arterial hypertension as concomitant, secondary to kidney disease or as a symptom of kidney disease. In the general population of people with high blood pressure, such hypertension is present in less than 10% of cases. Such hypertension is divided into two parts: associated with the pathology of the large vessels of the kidneys, and associated with the kidney tissue itself. Speaking of the first option, we single out renovascular hypertension, namely hypertension associated with a decrease in blood flow in the renal arteries.
This condition can be either congenital, which is more common in patients with "young", early hypertension, or acquired. The acquired pathology is more common - this is, first of all, atherosclerosis of the renal arteries, by analogy with the coronary arteries: plaque - stenosis - reduced blood circulation, in the case of the kidney - of the entire organ. The kidney responds to "malnutrition" by producing substances that raise blood pressure (BP). If a person already had arterial hypertension, it will become more severe, medications will no longer help. Here we need to think about what caused the aggravation of hypertension. Laboratory tests come to the aid of the doctor and the patient, revealing a decrease in the function of a kidney suffering from insufficient blood supply, in which sclerosis processes develop - that is, the replacement of active renal tissue - with an analogue of scar tissue that does not fulfill the tasks assigned to this important organ. The way out of this situation is to find and confirm the cause of the decrease in blood circulation, to apply surgical or conservative treatment of renovascular hypertension. To some extent, renovascular hypertension detected in time is more positive, since by eliminating the cause, we can hope for a favorable course of the disease, if not with a complete recovery, then with a significant improvement.
Diagnostics
Among the actual diseases of the kidney tissue, it is worth highlighting the main group of diseases - this is glomerulonephritis. Glomerulo - the very glomerulus of the smallest capillaries that filters the primary urine from the blood, surrounded by a special renal tissue. In many, the glomeruli make up the structural backbone of the kidney, along with the tubules, which work to concentrate urine. In general, urine analysis for any doctor is a source of knowledge about the patient. Most of the processes in the human body are reflected in the composition of urine, the study of various substances in the urine by laboratory methods provides tremendous information, often being the most important diagnostic criterion for rather complex diseases and conditions of the body. So, starting with a simple but very valuable clinical urinalysis, a doctor can make or reject a diagnosis of kidney disease, such as glomerulonephritis.
By detecting changes in the analysis of urine and taking into account various facts from the anamnesis of the disease (medical history), the general practitioner can determine whether this disease is acute or chronic. The actions of the doctor and the patient in these cases differ significantly. These illnesses sometimes proceed in completely different ways. Acute or subacute rapidly progressive glomerulonephritis often requires inpatient treatment with constant medical supervision. Chronic glomerulonephritis always requires clarification of the morphological features of the lesion of the renal tissue. The absolute standard for diagnosing chronic glomerulonephritis and a number of kidney diseases is to obtain a biopsy of kidney tissue and establish a diagnosis by morphological examination.
We often want to get by with "less blood", minimally invasive diagnostic tools - a CT scan, some miraculous hardware examination method. In order not to waste extra money, the patient's strength, and more importantly, the patient's life time, modern medicine has created algorithms, clear recommendations for examination and treatment. These recommendations are based on the results of statistical analysis of many studies. To the question often asked by the patient - is it enough to "enlighten" the whole body or the kidneys separately to make a diagnosis, the doctor gives a negative answer. This doctor's position is based on a diagnostic algorithm, in which each, even the most modern and very expensive diagnostic method, has its own limitations and indications and a place in the order of research application.
The doctor and the patient always want to quickly determine the diagnosis and choice of treatment. However, in many cases, in addition to active diagnostic actions, patience, a thoughtful analysis of the situation, and, which can be tedious, observation of the disease for some time are required from the doctor and the patient.
Treatment of hypertension
Treatment of almost any hypertension, whether it is essential or secondary, is always long-term, often lifelong. It can take a long time from the onset of the disease to the diagnosis. And this time without treatment is time lost for the human body. The very fact of increasing blood pressure contributes to the development of pathological processes in the heart and vascular wall. Therefore, it is important to start drug therapy early, whatever the cause of hypertension. Patients often avoid taking pills that they feel is not justified. In the case of arterial hypertension, treatment at any stage of the disease is justified. This is especially true for patients with kidney disease. The speculative resistance of "pill chemistry" is opposed by the possibility of living longer, moreover, without a heart attack, a stroke with kidney failure, or retinal detachment.
However, it is worth emphasizing the possibility of non-drug effects on hypertension. Significant weight loss, regular physical activity (walking, cycling, fitness, outdoor games) sometimes bring tremendous success, and allow you to reduce the dose of drugs, and, in especially successful cases, to abandon drug therapy. This applies primarily to patients with "young" essential hypertension.
Arterial hypertension is the most common cardiovascular disease. According to statistics, 10% of patients are diagnosed with renal hypertension, which occurs due to diseases of the organ responsible for filtering blood and removing fluid. This condition is not easy to diagnose, it is difficult in 25% of cases and leads to serious consequences. Therefore, it is necessary to consider in more detail the specifics of the disease, the features of its recognition and therapy.
What is renal hypertension?
This is an increase in pressure due to disruption of the kidneys and, accordingly, a breakdown in the function of regulating blood circulation. Such hypertension is also called secondary, since the increase in pressure in this case is a symptom of another disease, and not an independent process, which is typical for the diagnosis of hypertension. Most often, elderly people and young men suffer from such an ailment due to their greater body weight and, accordingly, a larger volume of the vascular bed. In case of resumption of kidney function, blood pressure returns to normal.
Enter your pressure
Move the sliders
Varieties of the disease
The renal form of hypertension is divided into 3 groups:
- Renoparenchymal diseases with involvement in the process of the membrane, which regulates the flow of fluid. The consequence of the defeat of the parenchyma are edema, protein in the blood, urine due to reverse blood outflow. This category includes diabetes, kidney stones, pyelonephritis, glomerulonephritis, systemic diseases (such as lupus erythematosus, scleroderma), congenital structural defects, kidney tuberculosis.
- - characterized by a narrowing of the lumen of one or more vessels by 75%. It is less common, but leads to a more severe course. The causes of such disorders: atherosclerosis (especially in the elderly), squeezing of blood vessels (hematoma, cyst), anomaly in their development. In the treatment of this group of diseases, antihypertensive drugs are ineffective.
- Mixed - arterial hypertension syndrome is caused by damage to both the parenchyma and blood vessels. Similar changes can occur in kidney diseases: nephroptosis, tumors, cysts.
Causes and pathogenesis
Arterial hypertension worsens the condition of the kidneys over time, and various kidney diseases can cause an increase in blood pressure. Hypertension and kidneys - there is a mutual relationship between them: due to an increase in pressure, kidney function is impaired, and, on the other hand, the pathology of this organ leads to arterial hypertension. Renal hypertension is caused by 3 mechanisms:
- An increase in blood flow leads to a violation of filtration, the accumulation of water and sodium ions. Because of this, a hormone is actively produced that promotes sodium absorption, causing vascular hypertonicity due to swelling of their walls. That is, the pressure rises due to an increase in the amount of fluid outside the cell and swelling of the artery wall.
- Due to improper functioning of the kidneys, a number of biologically active substances are released: renin is released in a larger volume due to vasoconstriction, and, interacting with the protein, forms angiotensin-II. It in itself increases the tone of the blood vessels, and also increases the production of aldosterone, which increases the absorption of sodium and thereby exacerbates swelling of the arteries.
- The depressor function of the organ suffers - the supply of hormones that reduce blood pressure by removing sodium from the muscles of the vessels is depleted over time and consistently high pressure becomes the norm.
The reasons for the increase in pressure associated with the kidneys correlate with the types of pathology described, which are presented in the table:
Symptoms and specifics of the course
Headache is present with increased pressure associated with the kidneys. As with hypertension, patients experience difficulty breathing, weakness, dizziness, headache, tachycardia, and a sharp increase in pressure. However, kidney damage in hypertension causes the appearance of edema, pain in the lumbar region, an increase in the frequency and volume of urination. If the disease proceeds benignly, the symptoms slowly increase, the rise in blood pressure is stable, anxiety and irritability, and discomfort in the heart area are possible. characterized by rapid development, visual disturbances, nausea and vomiting, minimal difference between upper and lower pressure, severe headache. Subsequently, complications such as heart and kidney failure, lipid metabolism disorders, blindness, and cerebrovascular accident can join the clinical picture.
Setting the diagnosis
Such patients are examined by a therapist, after which he prescribes treatment. First of all, a change in pressure is detected when performing certain physical exercises and changing body position. Then take blood and urine tests, determining the presence of protein. Sometimes blood is taken directly from the veins of the kidneys in search of the enzyme. Through a stethophonendoscope, a systolic murmur is heard in the umbilical region. Thanks to ultrasound and MRI, it is possible to study the structure of the kidney, search for formations. Excretory urography is also used in the diagnosis to examine the urinary tract. Angiography and examination of the fundus can detect vascular changes, and radioisotope rheography shows the degree of dysfunction. If the doctor suspects oncology, a biopsy is used with further cytological examination.
Therapeutic measures
Medical treatment of pathology
Therapeutic diet is required in the treatment of renal hypertension. Treatment of renal hypertension is carried out by cardiologists together with nephrologists. Therapy begins with diet number 7. Sometimes with a transient increase in pressure, this is enough. In case of poor tolerance of the dietary table or an insignificant improvement in the condition, drugs called loop diuretics are added. These include Furosemide, Torasemide.
In renal failure, the degree of dysfunction is calculated based on glomerular filtration, which is subsequently taken into account during the selection of medications. Drugs used to normalize blood pressure are thiazide diuretics and adrenergic blockers. Some antihypertensive drugs improve kidney function. These include Dopegit and Prazosin.
