Low blood pressure in renal failure. Hypertension in kidney failure High blood pressure in kidney failure

Renal hypertension (hypertension) has its own characteristic features: blood pressure of 140/90 mm Hg and above, diastolic persistently increased, the disease begins at a young age, conservative treatment is ineffective, the course is often malignant, the prognosis is mostly negative. The vascular form - renovascular hypertension, it is also renovascular, accounts for 30% of all cases of rapid progression of the disease, and in 20% of cases, drugs against it are ineffective.

Classification

Renal hypertension (PH) is divided into three groups:

1. Parenchymal: develops in diseases with damage to the tissues of the kidneys (parenchyma), such as pyelo- and glomerulonephritis, renal polycystic, diabetes tuberculosis, systemic diseases connective tissue, nephropathy of pregnant women. All patients with such ailments are at risk for PH.
2. Vasorenal hypertension (renovascular): the cause of increased pressure is a change in the lumen of the renal arteries due to atherosclerosis, thrombosis or aneurysm (local expansion), or malformations of the vascular wall. Among children under ten years of age, almost 90% of renal hypertension is of the renovascular form; in the elderly it accounts for 55%, and in the category of patients with chronic renal failure - 22%.
3. Mixed nephrogenic arterial hypertension: is considered as a result of a combination of parenchymal kidney damage with altered arteries - with nephroptosis (prolapse of the kidneys), tumors and cysts, congenital anomalies of the kidneys and their vessels.

Mechanisms of disease development

The function of the kidneys is to filter arterial blood, remove excess water, sodium ions and metabolic products. The mechanism is simple and known from physics: the diameter of the "bringing" vessel is larger than the "carrying out" vessel, due to this difference, filtration pressure is created. The process occurs in the renal glomeruli, then the "purified" arterial blood returns to the artery. Such nonsense even got its name - a wonderful arterial network (lat. retemirabile), in contrast to the system of liver vessels, which also form a wonderful, but already a venous network.

The starting point for the start of nephrogenic arterial hypertension is a decrease in blood flow to the kidneys and a violation of glomerular filtration.

Sodium and water retention begins, fluid accumulates in the intercellular space, swelling increases. An excess of sodium ions leads to swelling of the vascular walls, increasing their sensitivity to vasopressor (causing vasoconstriction) substances - angiotensin and aldosterone.

Then the renin-angiotensin-aldosterone system is activated. Renin, an enzyme that breaks down proteins, is secreted by the kidneys and does not itself have the effect of increasing pressure, but in collaboration with one of the blood proteins forms active angiotensin-II. Under its influence, aldosterone is produced, which stimulates sodium retention in the body.

Simultaneously with the activation of substances that increase blood pressure, the reserves of prostaglandins and the kallikrein-kinin system, which can reduce this pressure, are depleted in the kidneys. A vicious circle (lat. circulus mortum) is formed, when the process of the disease "circulates", closing and supporting itself. This explains the reasons for the persistent increase in pressure in arterial hypertension of renal genesis.

Video: Occurrence of Renal Hypertension - Medical Animation

Symptoms

The complex of symptoms of renal hypertension is summarized from the signs inherent in arterial hypertension and kidney disease. The severity of disorders, the degree of their external manifestation, depend on the clinical form of the disease - benign (slowly developing) or malignant (quickly).

Benign: blood pressure is stable, there is no tendency to decrease, diastolic ("lower" pressure) is increased more than systolic ("upper"). The main complaints are discomfort in the heart, shortness of breath, weakness and dizziness. The general condition is satisfactory.

Malignant: diastolic pressure rises above 120 mm Hg. Art. Vision often suffers, perhaps its unexpected weakening and even complete loss associated with impaired blood supply to the retina (retinopathy). permanent, severe pain in the head, frequent localization - the back of the head. Nausea and vomiting, dizziness.

The main manifestations of nephrogenic arterial hypertension:

• The onset is sudden, does not depend on physical activity and stress;
• An increase in pressure is associated with sharp pain in the lower back (an important difference from essential hypertension) after an injury to the kidney area, either surgery or kidney disease;
• Age - young, hypertension progresses rapidly;
• Among the next of kin there are no hypertensive patients from whom the patient could inherit a tendency to hypertension;
• Increasing edema, dynamic development of symptoms (malignant course of the disease);
• Common medicines used to reduce blood pressure, do not work.

Establishing diagnosis

Examination: significantly higher blood pressure numbers than with hypertension. Diastolic pressure is more elevated. As a result, the difference between the upper and lower pressure decreases - the pulse pressure.

A characteristic symptom of vasorenal hypertension: during auscultation (listening) of the area above the navel, a systolic murmur is heard, which is carried out in the lateral parts of the abdomen and back, in the region of the costovertebral angle. It occurs with stenosis of the renal arteries, with the acceleration of blood flow through a narrow area in the phase of contraction of the heart. An aneurysm of the renal artery produces a systolic-diastolic murmur of the same localization, the blood flow forms eddies in the zone of vessel expansion in both phases - contraction and relaxation. You can distinguish between systolic and diastolic murmurs if you keep your finger on the pulse during auscultation - in the literal sense. Systolic murmur corresponds to the pulse wave, diastolic murmur is heard during the pause between beats.

Changes in the vascular pattern of the fundus: the retina is edematous, the central artery is narrowed, vessels of uneven diameter, hemorrhages. Vigilance quickly decreases and fields of vision fall out.

Ultrasound: receive data on the size and structure of the kidneys, possible developmental abnormalities. Detect tumors and cysts, signs of inflammation.

Doppler ultrasound angiography: a contrast agent is injected to assess renal blood flow. The Doppler effect is based on the degree of reflection of ultrasound from structures of different densities, in this case, with its help, the condition of the walls of the renal artery is determined.

Urography: after the introduction of contrast, a series of observations is made, determining the rate of distribution of the substance in the kidneys. In the renovascular form of renal hypertension, contrast enhancement is slow at the beginning, within 1-5 minutes from the start of the procedure, and intensifies at 15-60 minutes.

Dynamic scintigraphy: a radioisotope is injected intravenously; with renal artery stenosis, it reaches the kidney more slowly than normal.

Renal angiography: the leading method for determining the location, type and extent of changes in the renal arteries. Visualization of an aneurysm or stenosis and determination of its degree; the location of the arteries and their additional branches; distribution of contrast in the kidneys, their size and position - the spectrum of the diagnostic value of the study. During angiography, upon detection of stenosis of the renal arteries, a renin test is performed (the difference in the content of renin in the peripheral and blood flowing from the kidneys), proving or refuting the diagnosis of renovascular hypertension.

MRI and spiral computed tomography: allow you to conduct reliable and informative examinations, to obtain layered images of the kidneys and blood vessels.

Biopsy: a small piece of kidney tissue is taken, prepared for microscopic examination. Based on the results, the severity of the disease and further prognosis are specified.

Therapeutic measures

Nephrogenic arterial hypertension develops rapidly, affecting the brain, heart, and incapacitating the kidneys, so therapeutic methods are ineffective. It is important for the patient to provide assistance immediately after determining the cause of PG and direct maximum efforts to eliminate it. Unconditional priority - for invasive and surgical methods.

Balloon angioplasty: the stenosed areas are expanded by inflating the balloon at the end of the catheter inserted into the renal artery. The combination with strengthening the wall with a micro prosthesis (stent) will protect the vessel from re-narrowing.

Operations: possible only with the preserved functionality of the kidneys. They are used for complex stenoses, blockage of the artery lumen, ineffectiveness of balloon angioplasty. According to indications - removal of the affected kidney.

Therapy: the treatment of renal hypertension combines drugs to influence the underlying disease (in the parenchymal form), as well as drugs that block the formation of angiotensin-II (Captopril) and reduce the activity of renin production (Propanolol).

Prognosis: favorable, if after the operation a decrease in pressure began and atherosclerosis did not develop in the kidneys. Unfavorable - with a problem with both kidneys, the appearance of complications in the form of heart, kidney failure, strokes.

Symptoms and treatment of kidney pressure with pills and folk remedies

Renal hypertension is characterized by high blood pressure due to malfunctioning of the kidneys. It differs from ordinary hypertension in that high blood pressure is difficult to reduce with antihypertensive drugs and requires special treatment. Self-medication is strictly prohibited, as complications can be fatal. It is best to prevent the development of the disease, but first you need to study it, which we will do.

How to lower kidney pressure

Classification of renal hypertension

• renoparenchymal,
• renovascular,
• mixed.

Renoparenchymal renal hypertension develops as a complication of various renal diseases.

The most frequent of them:

• glomerulonephritis - inflammation of the glomeruli of the kidney (glomerulus);
• diabetic nephropathy - complications of diabetes mellitus;
• vasculitis - inflammation of blood vessels;
• pyelonephritis - inflammation of the kidney calyx;
• urolithiasis - the formation of stones in the urinary system. Stones can cause acute renal failure;
• hydronephrosis - progressive expansion of the renal pelvis and calyx due to a violation of the outflow of urine;
• kidney tuberculosis - an infectious disease caused by Koch's bacillus;
• polycystic kidney disease - cystic degeneration of the kidney parenchyma;
• amyloidosis of the kidneys - a complication of various inflammatory diseases, most often systemic;
• nephropathy of pregnant women - occurs due to excessive stress on all body systems.

The main mechanism of development is the activation of pressor systems and the deactivation of depressor systems. This is due to a violation of the water-electrolyte balance. Due to pathological processes of the kidney parenchyma, the number of functional nephrons decreases. This leads to poor filtration and excretion of sodium from the body. There is hypernatremia and hyperhydration - water retention.

What is kidney pressure

The volume of circulating blood increases and the preload on the heart increases. The Frank-Starling law works: the more the heart muscle is stretched by the incoming blood, the stronger the heart contraction, and the more blood is pushed into the aorta. Inflammation of the interstitium of the kidneys can also trigger the renin-angiotensin-aldosterone system. It is a hormonal and most powerful mechanism for increasing blood pressure in the body.

The juxtaglomerular apparatus of the kidneys, located in the interstitium, produces renin, a hormone that starts the entire system. Under the influence of renin, angiotensinogen (synthesized in the liver) is converted to angiotensin I. Further, under the influence of ACE, angiotensin I is converted to angiotensin II. It is this substance that is the most powerful vasoconstrictor in the human body. Vascular receptors (mainly arteries) capture angiotensin II from the bloodstream and constrict. Thus, blood pressure rises. Under the influence of angiotensin II, aldosterone is released - a substance that retains sodium in the body, and sodium retains water.

As a result, you increase the volume of circulating blood due to water, and the Frank-Starling law works again. In addition to the activation of the pressor systems, there is also an inhibition of the depressor systems. Due to damage to the kidney parenchyma, the synthesis of factors of the kallikrein-kinin system is reduced. The concentration of vasodilating prostaglandins and nitric oxide in the blood decreases. Vasospasm increases, and blood pressure rises.

Renovascular hypertension is based on pathologies of the renal artery (RA).

These include:

• PA dysplasia is a pathology in which smooth muscle the muscular membrane of the vessel degenerates into fibroblasts, due to which “constrictions” form in the focus of changes. The consequence of this pathology is the narrowing of the lumen of the vessel and impaired blood flow.

Kidney pressure: symptoms and treatment

• PA stenosis is a narrowing of the lumen of one or both renal arteries. Pathology is accompanied by impaired perfusion of the night.
• Atherosclerosis is the formation of atherosclerotic plaques.
• VA thrombosis - overlapping of the lumen of the vessel by the formed thrombus.
• AVA aneurysm is a saccular dilatation of a vessel. At the site of expansion, a swirl of blood occurs, blood clots can form, and kidney perfusion decreases.
• Panarteritis PA - inflammation of all layers of the artery, leads to narrowing of the lumen and deterioration of blood flow in the kidney.
• Nephroptosis - the descent of the kidney leads to an inflection of the VA and a deterioration in perfusion.

Development mechanism. All vascular pathologies of the renal artery are united by a deterioration in blood flow. For normal functioning of the kidneys, the pressure in the PA must be maintained at least 70 mm Hg. Art. If it is below this, the kidneys will stop filtering the blood, which will lead to acute renal failure. Therefore, compensatory mechanisms are launched in the body to improve kidney perfusion. The most effective system is the renin-angiotensin-aldosterone system described above.

With mixed renal hypertension, both vascular pathology and parenchymal pathology can be seen. Often this combination can be seen in oncological processes. Treatment of such patients is mainly symptomatic and not always successful.

Kidney pressure: symptoms and treatment, pills

Renal hypertension is always a secondary disease

Signs of the disease

Renal hypertension is always a secondary disease, which is a complication of other pathologies. In the first place will be the symptoms of the underlying disease. If high blood pressure is added to the symptoms of the underlying pathology, this may be a sign of renal pressure. To verify the diagnosis, be sure to consult a doctor.

kidney pressure symptoms

Symptoms that can occur with increased pressure of any etiology:

• headache,
• dizziness,
• nausea,
• drowsiness,
• fatigue,
• dyspnea,
• nose bleed,
• blurred vision,
• burning in different parts of the body.

Symptoms in different forms

With renoparenchymal hypertension, in addition to symptoms of high blood pressure, there are always symptoms of the underlying disease.

Fibromuscular dysplasia of the renal artery

For various primary pathologies, there will be different symptoms, for example:

1. With glomerulonephritis - fever, headache, nausea, vomiting, back pain, general weakness, drowsiness, blood in the urine (hematuria).
2. In diabetes - a feeling of thirst, frequent urination, constant weakness, visual impairment, decreased potency, numbness of the limbs, slow wound healing, convulsions.
3. With vasculitis - general malaise, pallor of the skin, weight loss, fainting, sinusitis, skin rashes, hematomas.
4. With pyelonephritis - back pain, periodic weakness and fatigue, subfebrile condition, dry mouth, profuse sweating.
5. Urolithiasis - pain of any intensity in the lower back, pain in the lower abdomen, pain in the external genitalia, pain when urinating, blood in the urine, sand or small stones in the urine.
6. With hydronephrosis - renal colic, hematuria, pain when urinating.
7. With tuberculosis of the kidneys - subfebrile temperature, progressive weight loss, painless hematuria, pus in the urine, mucus in the urine.
8. With polycystic kidney disease - thirst, pus in the urine, malaise, back pain, headache.
9. With amyloidosis of the kidneys - symptoms of rheumatism.
10. With nephropathy in pregnant women - increased pressure, swelling throughout the body, poor sleep, back pain.

Symptoms of renovascular arterial hypertension:

1. With nephroptosis: back pain, urination disorders.
2. With panarteritis: general malaise, hyperthermia.
3. Aneurysm: no symptoms.
4. With atherosclerosis: dizziness, memory loss, headache.

Types of renal hypertension

Malignant form

This is the most severe manifestation of renal arterial hypertension. The pressure can rise to such numbers that the tonometer will go off scale. This condition is very difficult to correct and requires immediate hospitalization. Very often, this form ends with a hemorrhagic or ischemic stroke or myocardial infarction. Often, all the complications of high blood pressure also occur, only much faster than with a mild form of the disease.

According to statistics, 20% of patients without treatment die within 1 year. If you comply necessary measures, 90% survival rate.

You can reduce the likelihood of developing malignant hypertension if you follow some rules:

• give up all bad habits;
• give up unhealthy food;
• ensure regular physical education;
• periodic examination.

Diagnostics:

• general clinical blood test;
• blood chemistry;
• assessment of kidney function - Reberg's test;
• measuring the concentration of renin and aldosterone in the blood;

Ultrasound of the kidneys: how: renal hypertension

• excretory urography;
• angiography of the renal artery;
• radionuclide diagnostics;
• spiral CT and MRI;
• kidney biopsy.

Methods of treatment of renal hypertension

Attention! In no case do not self-medicate, it can be fatal.
Since renal hypertension is a secondary disease, the first thing to do is to remove its cause - to cure the underlying pathology.

At chronic diseases it is necessary to achieve stable remission and compensation of the patient's condition. If it is not possible to conduct etiotropic therapy that affects the cause, it is necessary to carry out symptomatic treatment aimed at relieving symptoms.

Medications

When prescribing drug treatment, it is necessary to take into account all the side effects and contraindications of drugs, because they are often found in renal hypertension. With extreme caution, diuretics are prescribed and those whose metabolites are excreted by the kidneys, and not by the liver. Beta blockers are preferred. Non-steroidal anti-inflammatory, ACE inhibitors, hypoglycemic, statins, thrombolytic, anticoagulants, antiplatelet agents, sedatives and many other drugs can also be prescribed.

Hardware treatment

Vibroacoustic effect on the kidneys

This method of treatment is based on vibroacoustic effect on the kidneys. A special device generates sound waves and transmits them to the kidneys. Thus, their function is restored, the synthesis of uric acid is enhanced and pressure is normalized.

Surgery

Renal artery stenting is a minimally invasive surgical treatment technique. First, access to femoral artery. Then the catheter goes to the renal artery and an arterial stent is installed at the site of stenosis - this is a metal spring that keeps the artery expanded. As a result, blood flow through the vessel will be restored.

Nutrition and lifestyle with kidney pressure

In order to increase the effectiveness of drug treatment, you need to follow a diet. It is necessary to exclude salt, pickles, smoked meats, alcohol, coffee and other harmful products from the diet. In addition, it is necessary to take into account the underlying and concomitant pathology. For example, with diabetes, you need to exclude sugar, sweets, limit flour products and learn how to count bread units.

Physical education has a positive effect on any pathologies. With sufficient physical activity, the overall metabolism improves, the load on the kidneys decreases, body weight decreases and blood sugar levels normalize.

It is also necessary to adjust the biological rhythms of the body. To do this, you need to do everything according to the schedule: eat, go to bed and wake up, exercise and relax. Thus, the production of hormones that control many processes is regulated and normalized.

How to lower blood pressure folk remedies?

Phytotherapy belongs to folk methods. For each organic pathology, there are suitable herbal teas, which are used to prepare teas and decoctions. Such treatment can be used only after the approval of your doctor, because you can harm your health. In addition, you can apply physiotherapy that will help reduce pressure - hot foot baths, massage, mustard plasters on the legs and more.

Post navigation

What is hypertension and how to reduce high blood pressure

With damage to the cardiovascular system, many are diagnosed with arterial hypertension - a disease that often leads to death or disability. As medical practice shows, pathology often affects people after 40, but there is always a risk of a violation at a younger age. The etiology of the disease is quite diverse, and the further life of the patient depends on timely access to doctors.

General concept of illness

Doctors are constantly reminded that an irresponsible attitude to health turns into disastrous consequences. Many complications can be avoided when a person notices the slightest problems in the body and tries to fix them with the help of specialists. Particular attention deserves hypertension, which is also called arterial hypertension or hypertension.

What is arterial hypertension and what is its peculiarity? Arterial hypertension just does not appear. It occurs when the pressure in a person in the blood vessels of a large circle becomes high, while high blood pressure maintains its performance for a long period.

To better understand what hypertension is, you need to understand the functioning of pressure in the arteries.

It happens:

• systolic;
• diastolic.

Systolic is the top number, it determines the level of pressure at the moment when the heart contracts. Diastolic, respectively, is the lower indicator, by which it is easy to know the amount of pressure when the organ is relaxed.

The systolic value is affected by:

1. The force of the heart contraction.
2. Blood wall resistance.
3. Compression frequency.

The established indicator of blood pressure, which is considered normal, is 120/80 mm Hg. Art. However, both a decrease in the level and its increase are quite acceptable. Why does this happen? Such a reaction of the body is often provoked by stress, changes in weather conditions, physiological conditions, and this process is natural.

As soon as the load becomes less, blood pressure stabilizes. But when high blood pressure turns into persistent symptom, which interferes with full-fledged activity, which means that you should immediately make an appointment with a doctor for an examination in order to begin treatment of hypertension.

Signs of high blood pressure in women are noted much more often with the onset of menopause, but in the stronger sex, hypertension becomes more severe, because men suffer more from atherosclerosis. Therefore, knowing how to quickly reduce pressure will be extremely necessary.

Etiological factors

Thanks to the smooth functioning of the heart, each cell receives the necessary substances and oxygen. With a decrease in the elasticity of the vessels through which blood circulates, or as a result of their clogging, the heart has to work more actively. In this case, it can be observed that blood pressure (systolic) has increased.

Arterial hypertension is a disease that is difficult to determine in the early stages, because it can go almost unnoticed for many years. That is, the patient already has hypertension, and the symptoms are common.

People may ignore manifestations in the form of:

• headaches;
• regular fatigue;

• dizziness;
• repeated increase in blood pressure;
• aches in the joints;
• irritability and so on.

High blood pressure is dangerous in itself, even if there are no additional symptoms. Therefore, it will be useful to know how to quickly lower the pressure, as well as the causes of hypertension, in order to suspect dangerous changes in the functioning of the body in time.

Arterial hypertension is often provoked by:

• Gender identity. Women are at greater risk, especially with the onset of menopause.
• Age. Hypertensive disease is detected more often in older people, because over time, blood pressure values ​​​​increase.
• Heredity. Caution should be exercised by those who among the relatives of the first line have patients with hypertension. And the more such people, the more attentive you should be to your condition, and then the question of how to cure hypertension forever will not arise.
• Excessive nervous strain. When a stressful situation occurs, adrenaline is released. Because of it, the heart rate quickens, respectively, the blood is pumped in a larger volume than before, which will increase the blood pressure values. If such a load is constantly present in a person’s life, the vessels wear out, and blood pressure becomes chronic.
• Alcohol abuse. Regular consumption of alcohol can increase blood pressure, and every year the numbers will grow more and more.
• Smoking addiction. Due to tobacco smoke, vasospasm occurs. Arterial walls are damaged both from nicotine and from other components present in tobacco smoke. And if there is hypertension, then before treating it, it is worth putting an end to harmful addictions.

• Atherosclerosis. These are common causes of high blood pressure in men. The elasticity of blood vessels is lost due to the accumulation of cholesterol, as well as as a result of regular smoking. The formed plaques interfere with normal blood flow, as the lumen of the vessels narrows. Thus, blood pressure rises and at the same time, atherosclerosis progresses. This pathology and hypertension are interrelated, so treatment is necessary.
• Too much salt in meals. When too much dietary sodium accumulates, narrowing of the arterial lumens occurs. Therefore, foods that increase the risk arterial hypertension, should be excluded.
• Overweight. Obese people often suffer from hypertension because it is a condition in which atherosclerosis develops due to the consumption of large amounts of animal fats.
• Hypodynamia. If a person does not move enough, the heart becomes weaned from the load, and material metabolism slows down. Lack of physical activity depletes the nervous system.

It becomes clear that the causes and treatment of pathology are interconnected.

Varieties of pathology

Hypertension is studied very carefully by scientists, because it is a disease that, if not diagnosed in time, can cause complications. There is a classification of arterial hypertension, which was developed taking into account various factors.

By indicators of blood pressure classification hypertension distinguishes between several degrees of the disease:

• the first (soft) - 140-159 / 90-99 mm Hg. Art.;

• the second (moderate) - 160-179 / 100-109;
• the third (severe) - the upper indicator exceeds the value of 180, the lower - 110.

Hypertension has stages depending on the presence of lesions, so the classification will be as follows:

• Stage 1 - there is increased pressure, but no symptoms indicating changes in the internal organs appear;
• Stage 2 (stable) - blood pressure rises regularly, organs that are the main targets are affected;
• Stage 3 (sclerotic) - there is a critical increase in the level of blood pressure, as well as sclerotic disorders affecting the vessels of target organs.

Since arterial hypertension often affects important organs, there is a classification according to which the disease can take the form of:

• renal;
• cardiac;
• cerebral;
• mixed.

Hypertension also happens:

• Benign (slow-flowing). Symptoms of hypertension appear slowly over a long period. The disease periodically worsens and subsides. If therapy is carried out on time, this will help reduce the likelihood of consequences.

• Malignant. High blood pressure appears rapidly, but treatment is often useless. In this case, the patient may suffer from renal pathologies.

In addition, arterial hypertension by origin occurs:

1. primary;
2. secondary.

Whatever type of arterial hypertension is, it will have characteristic symptoms.

Manifestations of pathology

Depending on the stage of hypertension, a clinical picture will be formed.

If first-degree hypertension is diagnosed, the condition is accompanied by:

• periodic increase in blood pressure, which normalizes on its own;
• mild pain in the head;
• minor sleep problems
• fatigue.

In the presence of 1 degree hypertension, as already mentioned, there are no signs of damage to the main organs. At stage 2 of hypertension, certain lesions already occur.

Hypertension, which has reached the second stage, manifests itself in the form of:

• vasoconstriction (localized or widespread);
• atherosclerotic plaques;
• left ventricular hypertrophy;
• chronic renal failure;
• angiospasm of retinal vessels.

The most difficult degree is the third. As a result of the occurrence of 3 degrees of arterial hypertension due to circulatory failures, numerous disorders in the functioning of various organs are observed.

Third degree hypertension can result in:

• heart failure;
• angina;
• stroke
• blockage of arteries;
• eye hemorrhages;
• blindness;
• aortic dissection and other complications.

Hypertension, or rather, its symptoms, is caused by provoking factors.

Secondary (symptomatic) hypertension is diagnosed in 5-10% of patients. Hypertension of this type of causes is quite obvious. It is the result of damage to the organs that regulate blood pressure. In other words, this is a complication of emerging pathologies.

Unfortunately, patients often ignore the symptoms that appear with high blood pressure. They justify the malaise with fatigue from exertion. But hypertension, which is not recognized in time, can reach an extreme degree in its development, which will certainly lead to complications.

Increasing pressure should be taken as a signal of possible danger.

People who have symptoms of high blood pressure are more likely to experience:

1. Damage to the vessels of the lower extremities.
2. Ischemia of the heart.
3. Stroke.

Therefore, as soon as certain signs of high blood pressure occur in a person, you should immediately go to the hospital for an examination.

This is about:

• frequent pain in the head;
• flickering "flies" before the eyes;
• tinnitus;
• dizziness;
• tachycardia;
• cardiac pain discomfort;
• nausea;
• weakness;
• puffiness of the face in the morning;
• numbness and swelling of the limbs;
• anxiety;
• irritability.

It is impossible to allow the progression of the pathology, because the signs will inevitably worsen over time. You need to take steps to help lower your blood pressure. The main thing is that the treatment of hypertension is supervised by a qualified specialist.

The essence of the treatment

A patient who has signs of high blood pressure must necessarily know how to reduce pressure. Only after a thorough diagnosis, the attending physician will prescribe drugs that will be used to treat hypertension.

During the examination, the specialist must identify the causes of hypertension. In addition, the patient is obliged to tell the doctor what signs of hypertension bother him. It is forbidden to take medications that lower blood pressure, which are selected independently.

How exactly will doctors treat high blood pressure?

Therapy is carried out with the help of:

• diuretics;
• alpha-blockers;
• beta-blockers;
• ACE inhibitors;
• angiotensin II antagonists;
• calcium antagonists.

You can bring down high blood pressure with:

• Hypothiazide;
• Indapamide;
• Triamterene.

How to treat high blood pressure so as not to harm yourself? If it is supposed to be taken once a day, it is better to drink a medicine that reduces the blood pressure coefficient in the morning. It is important to monitor the condition of the kidneys.

Lowering blood pressure is carried out through the use of alpha-blockers. The body tolerates them well. True, after the first dose, the patient may feel dizzy and faint. This happens when a person tries to get out of bed.

How to treat hypertension in order to prevent such a condition when you first take the drug?

1. Before knocking down high pressure values, diuretics should first be canceled.
2. The prescribed drug (Doxazosin, Terazosin) is taken in a minimal amount.
3. It is better to drink the medicine at night.

Signs of hypertension are eliminated by beta-blockers (Atenolol, Bisoprolol, Carvedilol). Thanks to them, the action of the central nervous system on the heart is blocked, and the number of heart contractions decreases. However, caution does not hurt, since various side effects are possible. Treatment begins with small doses.

How to quickly reduce high blood pressure? ACE inhibitors are effective. Patients perfectly tolerate the treatment of arterial hypertension with Captopril, Enalapril, Ramipril and other similar drugs. They contribute to the expansion of peripheral vessels and do not allow the hormone angiotensin II, due to which the vessels narrow, to form.

How to lower the pressure if it is not possible to do this with the help of ACE inhibitors? In this case, the patient is prescribed antagonists of the aforementioned hormone. It should be said that the named group of drugs, which includes Valsartan, Losartan, Candesartan, can act much more effectively than ACE inhibitors.

The appointment of calcium antagonists (Verapamil, Nifedipine, Plendil) contributes to:

• vasodilation;
• an increase in their diameter;
• prevention of stroke.

Can hypertension be cured? Of course, it is better not to wait until the disease manifests itself in full force. If a person is concerned about high blood pressure, he should ask the doctor what to do. There is a lot of information on how to lower blood pressure, so you should first consult with doctors, otherwise you can seriously harm yourself.

How to get rid of high blood pressure? Patients who want to know how to get rid of hypertension for good must completely rethink their lifestyle.

Necessary:

1. Take care of daily physical activity, the main thing is that it be moderate.
2. Organize your schedule correctly. Be sure to alternate work and relaxation.
3. Give up bad habits - smoking and addiction to alcohol.
4. Bring back the weight.

What to do with high pressure?

The therapy should never be interrupted. If the pressure indicators become critical again, damage to target organs cannot be avoided. The treatment of hypertension is quite long. The main thing is to strictly follow medical advice.

High blood pressure is considered one of the main problems of the century, this indicator directly indicates the functionality of blood vessels and the heart. Patients who go to the hospital do not always know how the kidneys affect blood pressure. Between them there is a pathogenetic relationship, the disease belongs to the secondary type of hypertension.

Kidney pressure - what is it

The considered pathology is diagnosed in 10-30% of cases with the development of hypertension. Kidney pressure - what is it? The disease develops with any pathology in the work of the kidneys. This organ in the human body is responsible for filtering arterial blood, removing excess fluid, protein breakdown products, sodium, and harmful substances that accidentally entered the circulatory system.

Increased pressure due to the kidneys appears when there is a violation in the work of the organ. Blood flow is reduced, sodium, water are retained inside, edema is formed. Sodium ions, accumulating, cause the walls of blood vessels to swell, which leads to an increase in their sensitivity. Kidney receptors begin to actively secrete the enzyme "renin", which turns into "angioteniz", then "aldosterone" is obtained from it. These substances affect the vascular tone, the gaps in them decrease, which leads to an inevitable increase in pressure.

Causes of nephrogenic arterial hypertension

The main task of the kidneys is to filter the blood, timely removal of water, sodium. Renal arterial hypertension begins to develop at the moment when the amount of incoming blood decreases. The vessels increase, the susceptibility to enzymes increases, at the same time the system is activated, which increases the production of aldosterone and sodium accumulates. This becomes a provoking factor in the growth of blood pressure and a decrease in the amount of prostaglandins that contribute to its reduction. Nephrogenic arterial hypertension - the causes of the development of this pathology:

• vascular injury;
• thrombosis, dysplasia, embolism, hypoplasia;
• anomaly of the aorta, parts of the urinary system;
• arteriovenous fistula;
• aneurysm;
• atherosclerosis of the artery;
• nephroptosis;
• arterial cysts, hematomas, compressed tumor;
• aortoarteritis.

kidney pressure symptoms

The disease begins, as a rule, suddenly, accompanied by an increase in blood pressure with pain in the lumbar spine. The tendency to this pathology can be inherited from parents. Even when taking medication to lower the pressure, relief does not occur. Renal hypertension manifests itself against the background of pathologies of the organ in question. The trigger mechanism can be: diabetes mellitus, pyelonephritis, glomerulonephritis. Renal pressure - the symptoms will necessarily be associated with the underlying pathology. The most common complaints are:

• urge to urinate more often than normal;
• increase in temperature of a periodic nature;
• pain in the lumbosacral region;
• general malaise, fatigue;
• increase daily allowance urine 2 times.

Treatment of renal hypertension

It is recommended to treat nephropathy comprehensively, it is necessary to establish the cause of the increase in pressure, eliminate it, and stop the symptoms. Renal hypertension - treatment can be carried out with the help of drugs (tablets, injections of solutions, etc.), folk remedies or through surgery. The last option is an extreme measure, which is necessary for congenital malformations or stenosis of the renal arteries. As a rule, balloon angioplasty or phonation of renal hypertension is performed.

How to lower kidney pressure at home

If the disease is on initial stage and does not cause serious pain, disturbances in the functioning of the body, then you can treat yourself at home. First, you should consult with your doctor so that he assesses the degree of development of hypertension and tells you how to effectively lower kidney pressure at home. For these purposes, as a rule, diet therapy, infusions and herbs are used. folk recipes, light medications.

Pills for kidney failure

All therapy is aimed at lowering upper renal pressure, relieving pain, and solving the underlying problem that provokes such a condition in a patient. The signs of PG themselves indicate the development of a disease that affects the kidneys. The specialist must determine the relationship between pathologies and prescribe the correct course of treatment. As a rule, the following tablets are used for kidney failure:

1. Antihypertensive drugs. Prazosin, Dopegyt, especially, have a good effect. with the secondary development of pressure in the kidneys. Medicines have a protective effect on the organ until it restores its functions.
2. Adrenoblockers, thiazide diuretics. Their reception implies the rejection of a number of products (diet without salt), therapy has a long duration without interruption. When developing a course of treatment, the size of the glomerular filtration rate should be taken into account; only a specialist can do this.

With the timely start of treatment, these medicines help regulate pressure (lower and upper). One of the main dangers of this pathology is that renal hypertension progresses very quickly, the brain and heart will be affected, so it is important to start treating the disease as quickly as possible. If the effectiveness of drug therapy is low, it is necessary to do balloon angioplasty.

Folk remedies

This is one type of therapy that may be approved by a doctor. The effectiveness of infusions, decoctions depends on the stage and degree of development of the disease. It is necessary to combine the treatment of renal pressure with folk remedies with proper diet(eat food without salt, give up alcohol, etc.). You can regulate the pressure using the following recipes:

1. Bearberry infusion. Take 2 tbsp. l. crushed plant, pour into a glass of boiling water. The infusion will be ready in 30 minutes. Drink it 4 times a day for 20 ml.
2. The next recipe is a collection of 5 tbsp. l. flax seeds, 2 tbsp. l. birch leaves, 1 tbsp. l. blackberry and strawberry leaves. Use a coffee grinder to grind all the ingredients, you should get a powder. Take 2 tbsp. l. finished mass for 0.5 liters of boiling water. The remedy should be infused for 7 hours, then take 5 times a day for 3 weeks. Then you should take a break for 7 days and continue taking the folk medicine.
3. The next infusion for the treatment of renal hypertension is prepared from 3 tbsp. l. carrot seeds, which should be ground in advance in a coffee grinder or blender. Place them in a thermos, fill with boiling water and leave for 10 hours. Strain the resulting composition and drink before meals 1 glass 5 times a day. The course of treatment lasts 14 days.

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.

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, such as:

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.

herbs for high blood pressure

You will learn about herbal preparations for high blood pressure, interesting recipes, useful tips and rules for taking medicinal herbs.

Learn more about how high blood pressure is considered.

Hypertension is diagnosed if a person's blood pressure values ​​are above 140/90 for several weeks. However, urinalysis can detect problems in early stage 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 procedure helps to determine the presence 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

Using combined methods, it is possible to determine the type of disease, after which it is worth proceeding to medical tactics.

Therapy of the disease is aimed at resolving two main tasks: resuming the functionality of the kidneys, restoring blood supply and reducing 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.

One of the innovative and effective therapeutic methods is phonation. It involves setting human body special devices that help restore the functionality of the kidneys, increase the production of uric acid, and restore blood pressure.

Phonation of the kidneys with the apparatus "Vitafon" at home

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).

Treatment of hypertension in renal artery stenosis involves the use of balloon angioplasty. The meaning of the technique is that a catheter is inserted into the artery, which is equipped with a balloon. This device swells and enlarges the artery. When the catheter is removed from the vessels, a special stent remains. As a result, the blood supply will be significantly improved, the vascular walls will be strengthened - and the pressure will decrease.

For information on how stenting is performed for renal artery stenosis, see this video:

Treatment of renal hypertension with folk remedies should be performed only if this has been previously agreed with the doctor. Herbal preparations, characterized by a pronounced diuretic effect, abound. But not all of them are considered harmless to the heart.

Incorrectly selected medicines contribute to the aggravation of the course of the pathology and can lead to serious complications.

One of the most important aspects is the diet, which increases the effectiveness of treatment and speeds up recovery. The list of allowed foods will depend on how badly the kidneys are affected.

Patients should minimize the consumption of liquids and table salt, exclude junk food, smoked meats, pickles from the menu. You should also minimize the consumption of alcohol and coffee.

About the treatment of renal hypertension, see this video:

If the therapeutic tactics are chosen unreasonably or by the patient himself without the knowledge of the doctor, this can lead to the appearance of severe and even fatal consequences. Elevated blood pressure levels in kidney disease act as a trigger for further health problems, namely:

Development of pathologies of the cardiovascular system;

kidney failure;

Changes in the composition of the blood;

Problems with cerebral blood supply;

Irreversible processes of vision function;

Disorders of lipid metabolism;

Arterial lesions.

Pathology prevention measures are no less important than the treatment of hypertension in renal failure, and are aimed at maintaining the full functioning of the kidneys and the cardiovascular system, since there is a close relationship in the functionality of these organs.
In order to prevent the occurrence of hypertension, it is necessary:

Control blood pressure, when the first signs of the disease appear, consult a doctor;

Minimize the intake of food that has a negative effect on the kidney receptors;

Minimize salt intake;

Completely give up bad habits;

Make the daily routine correct;

Do sport;

Overweight people should strive to lose weight through physical activity.

arterial hypertension in the elderly.

You will learn about the features of blood pressure after the age of 40, the rules for measuring blood pressure, risk factors for hypertension, methods of correction.

Learn more about whether you can play sports with high blood pressure.

In addition to all of the above, there is also prevention with the help of folk methods, which involves protection from an ailment of any form:

Every day, use a small spoonful of fish oil;

Add onion and garlic to food;

Drink freshly squeezed juices;

Purchase hawthorn tincture and take it as directed.

Being one of 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.

Stably high blood pressure against the background of various kidney diseases is a dangerous condition for both health and life, and requires immediate medical attention. Early diagnosis of renal hypertension and determination of the optimal timely course of treatment will help to avoid many negative consequences.

Renal hypertension (renal pressure, renal hypertension) belongs to the group of symptomatic (secondary) hypertension. This type of arterial hypertension develops as a result of certain kidney diseases. It is important to correctly diagnose the disease and take all necessary medical measures in time to prevent complications.

Disease prevalence

Renal hypertension is diagnosed in about 5-10 cases out of every 100 in patients who have evidence of stable hypertension.

Like another type of disease, this pathology is accompanied by a significant increase in blood pressure (starting from 140/90 mm Hg. Art.)

Additional signs:

• Stable high diastolic pressure.
• No age restrictions.
• High risk of acquiring malignant hypertension.
• Difficulties in treatment.

For practical use in medicine, a convenient classification of the disease has been developed.

Reference. Since hypertension is a very diverse pathology, it is customary to use disease classifications that take into account one or a group of existing criteria. Diagnosing a specific type of disease is a top priority. Without such actions, it is generally not possible to choose a competent correct tactics of therapy and designate preventive measures. Therefore, doctors determine the type of hypertension according to the reasons that caused the disease, according to the characteristics of the course, specific indicators of blood pressure, possible damage to the target organ, the presence of hypertensive crises, as well as the diagnosis of primary or essential hypertension, which is allocated to a separate group.

It is impossible to determine the type of disease on your own! Contacting a specialist and undergoing complex comprehensive examinations are mandatory for all patients.

Treatment with home methods in case of any manifestation of an increase in blood pressure (episodic, and even more so regular) is unacceptable!

Renal hypertension. Principles of disease classification

Group of renoparenchymal hypertension

The disease is formed as a complication of certain types of functional renal disorders. We are talking about unilateral or bilateral diffuse damage to the tissues of this important organ.

List of renal lesions that can cause renal hypertension:

• Inflammation of some areas of the kidney tissue.
• Polycystic kidney disease, as well as other congenital forms of their anomalies.
• Diabetic glomerulosclerosis as a severe form of microangiopathy.
• A dangerous inflammatory process with localization in the glomerular renal apparatus.
• Infectious lesion (tuberculous nature).
• Some diffuse pathologies proceeding according to the type of glomerulonephritis.

The cause of the parenchymal type of hypertension in some cases are also:

• inflammatory processes in the ureters or in the urethra;
• stones (in the kidneys and urinary tract);
• autoimmune damage to the renal glomeruli;
• mechanical obstacles (due to the presence of neoplasms, cysts and adhesions in patients).

Pathology is formed due to certain lesions in one or two renal arteries. The disease is considered rare. Statistics confirms only one case of renovascular hypertension out of a hundred manifestations of arterial hypertension.

Provoking factors

You should be wary of:

• atherosclerotic lesions with localization in the renal vessels (the most common manifestations in this group of pathologies);
• fibromuscular hyperplasia of the renal arteries;
• anomalies in the renal arteries;
• mechanical compression

As the immediate cause of the development of this type of disease, doctors often diagnose:

• nephroptosis;
• tumors;
• cysts;
• congenital anomalies in the kidneys themselves or vessels in this organ.

Pathology manifests itself as a negative synergistic effect from a combination of damage to the tissues and vessels of the kidneys.

Group of mixed renal hypertension

Conditions for the development of renal pressure

Studying the development process various kinds renal hypertension, scientists have identified three main factors of influence, these are:

• insufficient excretion of sodium ions by the kidneys, leading to water retention;
• the process of suppression of the depressor system of the kidneys;
• activation of the hormonal system that regulates blood pressure and blood volume in the vessels.

The pathogenesis of renal hypertension

Problems arise when there is a significant decrease in renal blood flow and reduced glomerular filtration efficiency. This is possible due to the fact that diffuse changes in the parenchyma occur or the blood vessels of the kidneys are affected.

How do the kidneys react to the process of reducing blood flow in them?

1. There is an increase in the level of reabsorption (reabsorption process) of sodium, which then causes the same process in relation to the liquid.
2. But pathological processes are not limited to sodium and water retention. Extracellular fluid begins to increase in volume and compensatory hypervolemia (a condition in which blood volume increases due to plasma).
3. A further development scheme includes an increase in the amount of sodium in the walls of blood vessels, which, as a result, swell, while showing increased sensitivity to angiotensin and aldosterone (hormones, regulators of water-salt metabolism).

We should also mention the activation of the hormonal system, which becomes an important link in the development of renal hypertension.

The mechanism of increasing blood pressure

The kidneys secrete a special enzyme called renin. This enzyme promotes the transformation of angiotensinogen into angiotensin I, from which, in turn, angiotensin II is formed, which constricts blood vessels and increases blood pressure. .

Development of renal hypertension

Consequences

The algorithm for increasing blood pressure described above is accompanied by a gradual decrease in the compensatory capabilities of the kidneys, which were previously aimed at lowering blood pressure if necessary. For this, the release of prostaglandins (hormone-like substances) and KKS (kallikrein-kinin system) was activated.

Based on the foregoing, an important conclusion can be drawn - renal hypertension develops according to the principle of a vicious circle. At the same time, a number of pathogenic factors lead to renal hypertension with a persistent increase in blood pressure.

Renal hypertension. Symptoms

When diagnosing renal hypertension, one should take into account the specifics of such concomitant diseases as:

• pyelonephritis;
• glomerulonephritis;
• diabetes.

Also pay attention to a number of such frequent complaints of patients, such as:

• pain and discomfort in the lower back;
• problems with urination, increased volume of urine;
• periodic and short-term increase in body temperature;
• persistent feeling of thirst;
• feeling of constant weakness, loss of strength;
• swelling of the face;
• gross hematuria (visible admixture of blood in the urine);
• fast fatiguability.

In the presence of renal hypertension in the urine of patients often found (during laboratory tests):

• bacteriuria;
• proteinuria;
• microhematuria.

Typical Features clinical picture renal hypertension

The clinical picture depends on:

• from specific indicators of blood pressure;
• functional abilities of the kidneys;
• the presence or absence of concomitant diseases and complications affecting the heart, blood vessels, brain, etc.

Renal hypertension is invariably accompanied by a constant increase in the level of blood pressure (with the dominance of an increase in diastolic pressure).

Patients should be seriously wary of the development of malignant hypertensive syndrome, accompanied by spasm of arterioles and an increase in total peripheral vascular resistance.

The diagnosis is based on taking into account the symptoms of concomitant diseases and complications. For the purpose of differential analysis, laboratory research methods are mandatory.

Renal hypertension and its diagnosis

The patient may be given:

• OAM (general urinalysis);
• urinalysis according to Nechiporenko;
• urinalysis according to Zimnitsky;
• Ultrasound of the kidneys;
• bacterioscopy of urinary sediment;
• excretory urography (X-ray method);
• scanning of the kidney area;
• radioisotope renography (X-ray examination using a radioisotope marker);
• kidney biopsy.

The conclusion is drawn up by the doctor based on the results of the patient's questioning (history taking), his external examination and all laboratory and hardware studies.

The course of treatment of renal hypertension must necessarily include a number of medical measures to normalize blood pressure. At the same time, pathogenetic therapy is carried out (the task is to correct the impaired functions of organs) of the underlying pathology.

One of the main conditions for effective assistance to nephrological patients is a salt-free diet.

The amount of salt in the diet should be kept to a minimum. And for some kidney diseases, a complete rejection of salt is recommended.

Attention! The patient should not consume salt more than the allowed norm of five grams per day. Keep in mind that sodium is also found in most foods, including their flour products, sausages, and canned food, so salting cooked food will have to be abandoned altogether.

Treatment of renal hypertension

In what cases is a tolerant salt regime allowed?

A slight increase in sodium intake is allowed for those patients who are prescribed as a medicine. salturetics (thiazide and loop diuretics).

It is not necessary to severely restrict salt intake in symptomatic patients:

• polycystic kidney disease;
• salt-wasting pyelonephritis;
• some forms of chronic renal failure, in the absence of a barrier to sodium excretion.

Diuretics (diuretics)

Classification of modern diuretic drugs (diuretics) according to the features of the therapeutic effect

Note. To determine the individual salt regimen, the daily release of electrolytes is determined. It is also necessary to fix the volume indicators of blood circulation.

Studies conducted in the development of a variety of methods to reduce blood pressure in renal hypertension have shown:

1. A sharp decrease in blood pressure is unacceptable due to the significant risk of impaired renal function. The baseline must not be lowered more than one quarter at a time.
2. Treatment of hypertensive patients with the presence of pathologies in the kidneys should be aimed primarily at lowering blood pressure to an acceptable level, even against the background of a temporary decrease in kidney function. It is important to eliminate the systemic conditions for hypertension and non-immune factors that worsen the dynamics of renal failure. The second stage of treatment is medical assistance aimed at strengthening renal functions.
3. Arterial hypertension in a mild form suggests the need for stable antihypertensive therapy, which is aimed at creating positive hemodynamics and creating barriers to the development of renal failure.

The patient may be prescribed a course of thiazide diuretics, in combination with a number of adrenergic blockers.

Several different antihypertensive drugs are approved for the treatment of nephrogenic arterial hypertension.

Pathology is treated:

• angiotensin-converting enzyme inhibitors;
• calcium antagonists;
• b-blockers;
• diuretics;
• a-blockers.

Medicines to lower blood pressure in kidney failure

The treatment process must comply with the principles:

• continuity;
• long duration in time;
• dietary restrictions (special diets).

Before prescribing specific drugs, it is imperative to determine how severe renal failure is (the level of glomerular filtration is being studied).

The patient is determined for long-term use a specific type of antihypertensive drug (for example, dopegyt). This drug affects the brain structures that regulate blood pressure.

Duration of medication

End stage renal failure. Features of therapy

Chronic hemodialysis is required. The procedure is combined with antihypertensive treatment, which is based on the use of special medications.

Important. With the ineffectiveness of conservative treatment and the progression of renal failure, the only way out is transplantation of a donor kidney.

In order to prevent renal arterial genesis, it is important to follow simple, but effective, precautions:

• systematically measure blood pressure;
• at the first signs of hypertension, seek medical help;
• limit salt intake;
• to ensure that obesity does not develop;
• give up all bad habits;
• lead a healthy lifestyle;
• avoid hypothermia;
• pay enough attention to sports and exercise.

Preventive measures for renal hypertension

conclusions

Arterial hypertension is considered an insidious disease that can cause various complications. In combination with damage to the renal tissue or blood vessels, it becomes deadly. Careful adherence to preventive measures and consultation with medical specialists will help reduce the risk of pathology. Everything possible should be done to prevent the occurrence of renal hypertension, and not to deal with its consequences.

What pills can be taken with hypertension?

• When is antihypertensive therapy administered?
• Drugs affecting the reninangiotensin system
• Calcium channel blockers
• Beta blockers
• Diuretics
• Centrally acting drugs

In recent years, hypertension has occupied a leading position among diseases of the heart and blood vessels. Previously, elderly patients suffered from an increase in blood pressure, but at present, pathology is detected in young people. The long course of the disease leads to dystrophic disorders in the tissues of the heart, kidneys, brain and organs of vision. by the most dangerous complications hypertension are considered myocardial infarction and cerebral stroke, which can lead to severe disability and cause death. The modern pharmacological industry produces a wide variety of drugs that help normalize the general condition of patients and improve the quality of life.

When is antihypertensive therapy given?

Pills for hypertension should be prescribed by a specialist after a comprehensive diagnosis, taking into account blood pressure numbers, the presence of concomitant diseases, contraindications, and the age of patients. The combination of these components during therapy is of great importance for achieving positive results and maintaining health at the proper level. When the pressure rises to 140/90 mm Hg. Art. and above, we can talk about the development of hypertension.

Risk factors for disease progression include:

• diabetes;
• hypercholesterolemia;
• obesity;
• hypodynamia;
• chronic stress;
• decreased glucose tolerance;
• bad habits;
• hereditary predisposition.

The debut of the disease begins with a periodic increase in blood pressure, usually against the background of a stressful situation. This causes a headache, drowsiness, weakness, sometimes flashing "flies" before the eyes. Often this condition is associated with overwork and do not go to the doctor. After a time, hypertension forms the activation of compensatory reactions in the body, which significantly smooth out the clinical picture. Patients cease to feel the pathological vasospasm, but the disease is constantly progressing.

When episodes of hypertension are detected in the early stages, drug therapy is not prescribed. Improvement can be achieved rational nutrition, physical education, the rejection of bad habits, the normalization of the regime of work and rest. After the occurrence of a persistent increase in blood pressure, it is recommended to drink one drug under the constant supervision of a doctor. With the ineffectiveness of monotherapy, several antihypertensive drugs or tablets with a combined composition are prescribed.

In the kidneys, with a decrease in pressure, the substance prorenin is produced, which, entering the bloodstream, turns into renin, and after interacting with a special protein, it is synthesized into an inactive substance angiotensin 1. Under the influence of resolving factors, it reacts with an angiotensin-converting enzyme (ACE) and acquires active properties - angiotensin 2. This substance has a vasoconstrictive effect, causes an increase in cardiac activity, promotes water retention in the body, and excites the centers of the sympathetic nervous system. Depending on the influence of the drug on a certain link of the reninangiotensive system, two groups of drugs are distinguished.

The active substance in the composition of the drug blocks the work of the enzyme of the same name. As a result, pressure and pulse normalize, the excitability of the nervous system decreases, and the excretion of fluid from the body increases.

List of funds:

• captopril;
• ramipril;
• enalapril;
• quinopril;
• zofenopril.

The appointment of drugs is contraindicated in pregnancy, diabetes mellitus, severe autoimmune pathologies, renal and hepatic insufficiency. Captopril is not suitable for long-term treatment diseases, especially in elderly patients with symptoms of atherosclerosis of the cerebral arteries. It is usually used to stop hypertensive crises - a sharp increase in blood pressure. Every third patient notes a dry cough while taking this group of drugs. If a side effect occurs, the product must be replaced.

The active substance in the composition of the drug blocks angiotensin 2 receptors. Sartans are new generation drugs that have been created in the last decade. They gently normalize blood pressure in hypertension, do not cause withdrawal syndrome, and can have a therapeutic effect for several days.

List of funds:

• candesartan;
• losartan;
• valsartan;
• telmisartan.

Medicines are contraindicated during breastfeeding, gestation, childhood, with a significant loss of fluid and an increase in the content of potassium in the blood.

In the cell membrane of muscle fibers there are special channels through which calcium enters and causes their contractility. This leads to vasospasm and increased heart rate. The drugs of this group close the pathways for calcium to move into the cell, thereby causing a decrease in the tone of the vascular wall, a decrease in the pulse, and a decrease in the load on the myocardium.

List of funds:

• diltiazem;
• verapamil;
• nifedipine;
• amlodipine;
• diltiazem;
• nifedipine;
• lacidipine.

Medicines are prescribed for hypertension, combined with angina pectoris and cardiac arrhythmias. Decrease in pulse rate is caused by verapamil and diltiazem. In recent years, nifedipine has ceased to be used in medical practice due to its short duration of action and the ability to cause side effects. Drinking tablets of this group is not recommended in old age, childhood and puberty, with liver failure, hypersensitivity to active ingredient, acute myocardial infarction. At the beginning of treatment, swelling of the extremities may occur, which usually disappears within a week. If edema persists for a long time, the drug must be replaced.

Beta receptors are located in the tissues of the kidneys, bronchi, and heart, which, when excited, can cause an increase in pressure. The hypotensive effect is achieved by combining the substance in the preparation with these receptors, preventing biologically active substances from affecting their work. For hypertension, selective drugs are recommended that interact exclusively with myocardial receptors.

List of funds:

• bisaprolol;
• atenolol;
• metoprolol;
• carvedilol;
• nebivolol;
• celiprolol.

The drugs are prescribed for resistant forms of hypertension, concomitant angina pectoris, cardiac arrhythmias, myocardial infarction. Non-selective drugs such as carvedilol, nebivalol, celiprolol are not prescribed for diabetes mellitus, signs of bronchial asthma.

Diuretic drugs affect filtration in the renal glomeruli, helping to remove sodium from the body, which pulls fluid along with it. Thus, the effect of the drug is associated with the loss of water, which reduces the filling of the bloodstream and normalizes high blood pressure in hypertension.

List of funds:

• spironolactone;
• indapamide;
• hydrochlorothiazide (hypothiazide);
• triampure;
• furosemide.

If potassium-sparing diuretics such as spironoloctone and triampur are used, replacement therapy is not required. Furosemide is recommended for the relief of acute attacks, as it has a pronounced, but short-lived effect. Means are contraindicated in anuria, lactose intolerance, electrolyte imbalance, severe diabetes mellitus.

Medicines of this group prevent overexcitation of the nervous system and normalize the work of the vasomotor center, which helps to reduce high blood pressure.

List of funds:

• methyldopa;
• moxonidine;
• rilmenidine.

Tablets are prescribed to patients with emotional instability, as well as to patients under stress and increased excitability. Additionally, it is recommended to drink tranquilizers, sleeping pills and sedatives.

If you experience the first symptoms of hypertension, you should seek the advice of a specialist. After a comprehensive examination, the doctor will tell you which drugs should be used to normalize general well-being. He picks the right combination medicines and their dosage, prescribe the time of taking the tablets and monitor their effectiveness. Only such an approach can stop the further progression of the pathology and exclude the occurrence of serious consequences. To maintain health, self-medication is strictly contraindicated.

Drugs to lower blood pressure

Target organs are those organs that are most affected by increased pressure, even if you do not feel this increased pressure. We already spoke about one such organ when we discussed hypertrophy of the left ventricular myocardium - this is the heart.

Another such organ is the brain, where, with high blood pressure, processes such as microscopic strokes can occur, which, if there are enough of them, can lead to a decrease in intelligence, memory, attention, etc. not to mention the strokes themselves.

The kidneys are also a target, as a result of increased pressure, the structures involved in the removal of toxins from the body die. Over time, this can lead to kidney failure.

The organs of vision, another suffering organ, changes occur in the retina - the area of ​​\u200b\u200bthe eye that is responsible for the perception of visual images, if you remember from the anatomy course, these are rods and cones, while both a decrease in visual acuity and its complete loss are possible.

Careful monitoring is necessary for all these organs, since by observing certain changes from year to year in dynamics, one can draw a conclusion about the rate of progression of the disease and the effectiveness of treatment.

Normal - systolic 120-129, diastolic 80-84

High normal - systolic 130-139, diastolic 85-89

Arterial hypertension of the 1st degree - systolic 140-159, diastolic 90-99

Arterial hypertension of the 2nd degree - systolic 160−179, diastolic 100−109

Arterial hypertension of the 3rd degree - systolic above 180, diastolic above 110

Isolated systolic hypertension - systolic above 139, diastolic less than 90

Symptoms of this disease are usually absent for a long time. Up to the development of complications, a person does not suspect about his disease if he does not use a tonometer. The main symptom is a persistent increase in blood pressure. The word "persistent" is paramount here, because. a person's blood pressure can also increase in stressful situations (for example, white coat hypertension), and after a while it normalizes. But, sometimes, the symptoms of arterial hypertension are headache, dizziness, tinnitus, flies before the eyes.

Other manifestations are associated with damage to target organs (heart, brain, kidneys, blood vessels, eyes). Subjectively, the patient may notice a deterioration in memory, loss of consciousness, which is associated with damage to the brain and blood vessels. With a long course of the disease, the kidneys are affected, which can be manifested by nocturia and polyuria. Diagnosis of arterial hypertension is based on the collection of anamnesis, measurement of blood pressure, detection of target organ damage.

One should not forget about the possibility of symptomatic arterial hypertension and exclude diseases that could cause it. Mandatory minimum examinations: general analysis blood with the determination of hematocrit, general urinalysis (determination of protein, glucose, urinary sediment), blood test for sugar, determination of cholesterol, HDL, LDL, triglycerides, uric acid and creatinine in blood serum, sodium and potassium of blood serum, ECG. There are additional examination methods that the doctor may prescribe if necessary.

Differential diagnosis of arterial hypertension is between symptomatic and essential. This is necessary to determine the tactics of treatment. It is possible to suspect secondary arterial hypertension on the basis of certain features:

1. from the very beginning of the disease, high blood pressure is established, characteristic of malignant hypertension
2. high blood pressure is not amenable to medical treatment
3. hereditary history is not burdened by hypertension
4. acute onset of the disease

Arterial hypertension in pregnant women can occur both during pregnancy (gestational) and before it. Gestational hypertension occurs after the 20th week of pregnancy and disappears after delivery. All pregnant women with hypertension are at risk for preeclampsia and placental abruption. In the presence of such conditions, the tactics of conducting childbirth change.

Methods of treatment of arterial hypertension are divided into drug and non-drug. First of all, you need to change your lifestyle (do physical education, go on a diet, give up bad habits). What is the diet for hypertension?

It includes restriction of salt (2-4 g) and liquid, it is necessary to reduce the intake of easily digestible carbohydrates, fats. Food must be taken fractionally, in small portions, but 4-5 times a day. Drug therapy includes 5 groups of drugs for the correction of blood pressure:

• Diuretics
• Beta blockers
• ACE inhibitors
• calcium antagonists
• Angiotensin II receptor antagonists

All drugs have different mechanisms of action, as well as their contraindications. For example, thiazide diuretics should not be used during pregnancy, severe chronic renal failure, gout; beta-blockers are not used for bronchial asthma, COPD, severe bradycardia, atrioventricular block 2.3 degrees; angiotensin-2 receptor antagonists are not prescribed in cases of pregnancy, hyperkalemia, bilateral stenosis of the renal arteries).

Very often, drugs are produced in a combined state (the following combinations are considered the most rational: diuretic + ACE inhibitor, beta-blocker + diuretic, angiotensin-2 receptor antagonists + diuretic, ACE inhibitor + calcium antagonist, beta-blocker + calcium antagonist). There are new drugs for the treatment of hypertension: imidazoline receptor antagonists (they are not in the international recommendations for treatment).

People who are predisposed to this disease are especially in need of prevention of arterial hypertension. As a primary prevention, it is necessary to lead an active lifestyle, go in for sports, as well as eat right, avoid overeating, excessive consumption of fats and carbohydrates, and give up bad habits.

All this is the most effective method of preventing hypertension.

Renal hypertension is an ailment caused by impaired functioning of the kidney and leading to a steady increase in blood pressure. Its treatment is long and necessarily includes a diet. Arterial hypertension of any nature is one of the most common cardiovascular diseases. 90-95% is actually hypertension. The remaining 5% are secondary, in particular, renal hypertension. Its share reaches 3-4% of all cases.

An increase in blood pressure is caused by a violation of any of the factors that regulate the activity of the heart. Moreover, hypertension is caused by emotional overstrain, which, in turn, disrupts the work of cortical and subcortical regulation and pressure control mechanisms. Accordingly, changes in kidney function due to increased pressure are secondary.

The job of the kidneys is to filter the blood. This possibility is due to the difference in the pressure of the incoming and outgoing blood. And the latter is provided by the cross section of the vessels and the difference in arterial and venous pressure. Obviously, if this equilibrium is disturbed, the filtration mechanism will also be destroyed.

With an increase in blood pressure, the volume of blood entering the kidneys also increases markedly. This disrupts the work of the body, since it does not make it possible to filter such an amount to remove all harmful substances.

As a result, fluid accumulates, edema appears, and this leads to the accumulation of sodium ions. The latter make the walls of sauces susceptible to the action of hormones that require a narrowing of the section, which leads to an even greater increase in pressure.

Since the vessels cannot work in this mode, renin is produced to stimulate them, which again leads to water retention and sodium ions. At the same time, the tone of the renal arteries increases, which leads to sclerosis - the deposition of plaques on the inner walls of the vessels. The latter interferes with normal blood flow and causes left ventricular hypertrophy.

In addition, one of the functions of the kidney is the production of prostaglandins, hormones that regulate normal blood pressure. With organ dysfunction, their synthesis decreases, which contributes to a further increase in pressure.

Renal hypertension is not an independent disease, but a consequence of some other primary disease. It is dangerous because it leads to kidney and heart failure, atherosclerosis and other serious diseases.

On the video about what renal hypertension is:

Abnormalities in the functioning of the renal arteries can occur with almost any kidney disease. but modern classification identifies 3 main groups.

Renoparenchymal - the cause is the defeat of the parenchyma. This is a shell of an organ, consisting of a cortical and medulla layer. Its function is to regulate the accumulation and outflow of fluid. In case of violations in its work, there is a reverse arterial blood flow, swelling, protein enters the blood and urine.

The following diseases cause diffuse changes in the parenchyma:

• lupus erythematosus, scleroderma and other systemic diseases;
• pyelonephritis and glomerulonephritis are the most common causes;
• urolithiasis disease;
• renal tuberculosis;
• diabetes;
• kidney anomalies, both congenital and acquired.

The reason may also be a permanent mechanical factor - squeezing the urinary tract, for example.

Renovascular - in this case, the cross section of one or more arteries is reduced by 75%.

Bilateral stenosis - the actual narrowing of the vessel, or stenosis of one organ very quickly causes kidney failure. Fortunately, renovascular hypertension is not common: only 1-5% of all cases. However, it is she who most often leads to a malignant course of the disease.

The causes of renovascular hypertension are:

• atherosclerosis - in 60–85%, especially in the older age group;
• anomaly in the development of blood vessels; mechanical compression - a tumor, hematoma, cyst, lead to the same result.

A distinctive feature of this group is the low effectiveness of antihypertensive drugs, even at very high pressure.

Mixed - this includes any combination of damage to the parenchyma and blood vessels. The cause may be cysts and tumors, nephroptosis, anomalies of arterial vessels, and more.

There are quite a few factors affecting the state and functioning of the cardiovascular system. Most of them can lead to an increase or decrease in blood pressure.

In relation to renal hypertension, there are 3 main causes:

• Retention of sodium and water ions is a common mechanism for the formation of hypertension in parenchymal lesions. With an increase in the amount of incoming blood, in the end, it leads to a violation of filtration and a kind of internal edema. The volume of extracellular fluid increases, which provokes an increase in blood pressure. Sodium ions are retained along with water.

In response, the production of digitalis-like factor increases, which reduces sodium reabsorption. But with kidney disease, the hormone is produced too actively, which leads to vascular hypertonicity and, accordingly, increases blood pressure.

• Activation of the RAAS renin-angiotensin-aldosterone system. Renin is one of the hormones that promote protein breakdown, and by itself does not affect the state of blood vessels. However, as the arteries narrow, renin production increases.

The hormone reacts with α-2-globulin, together with which it forms extremely active substance- angiotensin-II. The latter significantly increases the amount of blood pressure and provokes increased synthesis of aldosterone.

Aldosterone promotes the absorption of sodium ions from the interstitial fluid into the cells, which leads to swelling of the walls of blood vessels, and, therefore, to a decrease in the cross section. In addition, it increases the sensitivity of the walls to angiotensin, which further enhances vascular tone.

• Inhibition of the depressor system of the kidneys - the medulla of the organ performs a depressor function. The activity of renin, angiotensin and aldosterone causes the production of kallikrein and prostaglandins - substances that actively remove sodium, in particular, from the smooth muscles of blood vessels. However, the possibilities of the adrenal glands are not unlimited, and with pyelonephritis or other types of diseases they are very limited. As a result, the depressor capabilities of the organ are exhausted, and constant high pressure becomes normal.

Renal arterial hypertension is a difficult disease to diagnose due to the vague nature of the symptoms. In addition, the picture is complicated by other diseases: pyelonephritis, cysts, heart failure, and so on.

Common symptoms of renal hypertension include:

• a sharp increase in pressure for no apparent reason - 140/120 is the "starting point";
• pain in the lumbar region, not dependent on physical effort;
• swelling of the hands and feet;
• dull headache, usually in the back of the head;
• irritability, panic attacks;
• usually the disease is accompanied by visual impairment, up to its loss;
• weakness, possibly shortness of breath, tachycardia, dizziness.

Confusing renal hypertension with another disease is quite simple. But, given that it is this ailment that takes on a malignant character in 25% of cases, establishing the correct diagnosis is as relevant as possible.

More characteristic features arterial hypertension of renal origin, which, however, can only be established during a medical examination, are the state of the left heart ventricle, the value of diastolic pressure and the state of the fundus. Due to a violation in the blood circulation of the eye, the last sign allows you to diagnose the disease even in the absence of all other symptoms.

In relation to the totality of these signs, 4 symptomatic groups of hypertension are distinguished.

• Transient - the pathology of the left ventricle is not detected, the increase in blood pressure is unstable, changes in the fundus are also unstable.
• Labile - the increase in pressure is unstable and is of a moderate nature, but it no longer normalizes on its own. Narrowing of the fundus vessels and an increase in the left ventricle are detected during the examination.
• Stable - the pressure is constantly high, but antihypertensive therapy is effective. An increase in the ventricle and vascular disturbances are significant.
• Malignant - blood pressure is high and stable - about 170 - The disease develops rapidly and leads to damage to the vessels of the eyes, brain and heart. To the usual symptoms are added signs of CNS disorders: vomiting, severe dizziness, memory impairment, cognitive functions.

The reason for the examination is usually an increase in blood pressure and associated symptoms. In the absence of the latter - for example, with vasorenal hypertension, the disease can be detected by chance.

• The first stage of the examination is the change in blood pressure at different positions of the body and when performing certain exercises. The change allows you to localize the site.
• Blood and urine tests - in case of violations in the work of the kidneys, the protein in the blood confirms the diagnosis. In addition, blood is taken from the veins of the kidney to detect an enzyme that increases blood pressure.
• Vasorenal hypertension is accompanied by systolic murmur in the umbilical region.
• Ultrasound - allows you to establish the condition of the kidneys, the presence or absence of cysts, tumors, inflammation, pathologies.
• If a malignant course is suspected, an MRI is prescribed.
• Examination of the fundus - vasoconstriction, edema.
• Radioisotope rheography is carried out using a radioactive marker. Allows you to set the degree of functionality of the body. In particular, the rate of urine excretion.
• Excretory urography - examination urinary tract.
• Angiography - allows you to evaluate the condition and work of blood vessels.
• Biopsy - for cytological examination.

Treatment is determined by the severity of the lesions, the stage of the disease, general condition patient and so on.

Its purpose is to preserve the functionality of the kidney and, of course, cure the underlying disease:

• With transient hypertension, diet is often dispensed with. Its main principle is to limit the intake of sodium-containing products. This is not only table salt, but also other sodium-rich foods: soy sauce, sauerkraut, hard cheeses, seafood and canned fish, anchovies, beets, Rye bread etc.
• Patients with renal hypertension are prescribed dietary table No. 7, which involves reducing salt intake and gradually replacing animal proteins with vegetable ones.
• If sodium restriction does not give the desired result or is poorly tolerated, then loop diuretics are prescribed. With insufficient effectiveness, increase the dose, and not the frequency of administration.
• Drugs for the treatment of renal hypertension are prescribed when vasoconstriction does not leave a mortal danger.
• Of the medicines, drugs such as thiazide diuretics and andrenoblockers are used, which reduce the activity of angiotensin. Antihypertensive agents are added to improve organ function. Treatment must be combined with diet. Moreover, in both the first and second cases, the doctor must monitor the implementation of the diet, since the latter at first can lead to a negative sodium balance.
• In the terminal stages, hemodialysis is prescribed. In this case, antihypertensive treatment continues.
• Surgical intervention is carried out in extreme cases, as a rule, when the damage to the kidney is too large.
• With stenosis, balloon angioplasty is indicated - a balloon is inserted into the vessel, which is then inflated and holds the walls of the vessel. This intervention does not yet apply to surgical intervention, but the results are encouraging.

Balloon angioplasty

• If the plastic was ineffective, an arterial resection or endarterectomy is prescribed - removal of the affected area of ​​the vessel in order to restore the patency of the artery.
• Nephropexy can also be prescribed - while the kidney is fixed in its normal position, which restores its functionality.

The syndrome of renal arterial hypertension is a secondary disease. However, it leads to consequences quite serious, so it is necessary to pay special attention to this ailment.

A low-protein diet (MVD) eliminates the symptoms of uremic intoxication, reduces azotemia, symptoms of gout, hyperkalemia, acidosis, hyperphosphatemia, hyperparathyroidism, stabilizes residual kidney function, inhibits the development of terminal uremia, improves well-being and lipid profile. The effect of a low-protein diet is more pronounced when it is used in initial stage chronic renal failure and with initially slow progression of chronic renal failure. A low-protein diet, which limits the intake of animal proteins, phosphorus, sodium, maintains the level of serum albumin, maintains nutritional status, enhances the nephroprotective and cardioprotective effect of pharmacotherapy (ACE inhibitors). On the other hand, treatment with epoetin preparations, having an anabolic effect, contributes to long-term adherence to a low-protein diet.

The choice of a low-protein diet as one of the priority treatments for chronic renal failure depends on the etiology of nephropathy and the stage of chronic renal failure.

• In the early stage of chronic renal failure (creatinine less than 0.25 mmol / l), a diet with moderate protein restriction (1.0 g / kg of body weight) and a calorie content of at least 35-40 kcal / kg is acceptable. At the same time, vegetable soy proteins (up to 85%) are preferable, enriched with phytoestrogens, antioxidants and containing less phosphorus than meat, fish, and milk protein - casein. At the same time, products from genetically modified soy should be avoided.
• In chronic renal failure with a creatinine level of 0.25-0.5 mmol / l, a greater restriction of protein (0.6-0.7 g / kg), potassium (up to 2.7 g / day), phosphorus (up to 700 mg) is shown. /day) at the same calorie content (35-40 kcal/kg). For the safe use of a low-protein diet, the prevention of nutritional status disorders, it is recommended to use ketoanalogues of essential amino acids [ketosteril" at a dose of 0.1-0.2 g / (kg x day)].
• With severe chronic renal failure (creatinine more than 0.5 mmol / l), protein and energy quotas are maintained at the level of 0.6 g of protein per 1 kg of the patient's body weight, 35-40 kcal / kg, but potassium is limited to 1.6 g / day and phosphorus up to 400-500 mg / day. In addition, a full complex of essential keto / amino acids is added [ketosteril 0.1-0.2 g / (kg x day)]. Ketosteril not only reduces hyperfiltration and production of PTH, eliminates the negative nitrogen balance, but also reduces insulin resistance.
• In chronic renal failure in patients with gouty nephropathy and type 2 diabetes (NIDDM), a low-protein diet with lipid-lowering properties, modified with nutritional supplements with a cardioprotective effect, is recommended. Enrichment of the PUFA diet is used: seafood (omega-3), vegetable oil(omega-6), co-products, add food cholesterol sorbents (bran, cereals, vegetables, fruits), folic acid (5-10 mg / day). An important way to overcome uremic insulin resistance is the use of a complex that normalizes overweight exercise. At the same time, an increase in exercise tolerance is provided by epoetin therapy (see below).
• To reduce the intake of phosphorus, in addition to animal proteins, limit the consumption of legumes, mushrooms, white bread, red cabbage, milk, nuts, rice, cocoa. With a tendency to hyperkalemia, dried fruits (dried apricots, dates), crispy, fried and baked potatoes, chocolate, coffee, dried mushrooms are excluded, juices, bananas, oranges, tomatoes, cauliflower, legumes, nuts, apricots, plums, grapes, black bread are limited , boiled potatoes, rice.
• A sharp restriction in the diet of products containing phosphates (including dairy products) leads to malnutrition in a patient with chronic renal failure. Therefore, along with a low-protein diet that moderately restricts the intake of phosphates, drugs that bind phosphates in the gastrointestinal tract (calcium carbonate or calcium acetate) are used. An additional source of calcium is essential keto/amino acids in the form of calcium salts. In the event that the level of blood phosphates achieved at the same time does not completely suppress the hyperproduction of PTH, it is necessary to add active metabolites of vitamin D 3 - calcitriol to the treatment, as well as correct metabolic acidosis. If a complete correction of acidosis with a low-protein diet is not possible, citrates or sodium bicarbonate are prescribed orally to maintain the level SB within 20-22 meq / l.

1g Food Serving with 5g Protein

Enterosorbents (povidone, hydrolysis lignin, activated charcoal, oxidized starch, hydroxycellulose) or intestinal dialysis are used in the early stage of chronic renal failure or when it is impossible (unwilling) to follow a low-protein diet. Intestinal dialysis is carried out by perfusion of the intestine with a special solution (sodium chloride, calcium, potassium, together with sodium bicarbonate and mannitol). Taking povidone for 1 month reduces the level of nitrogenous wastes and phosphates by 10-15%. When taken orally for 3-4 hours, 6-7 liters of solution for intestinal dialysis remove up to 5 g of non-protein nitrogen. As a result, there is a decrease in the level of blood urea for the procedure by 15-20%, a decrease in acidosis.

Treatment of arterial hypertension

Treatment of chronic renal failure is the correction of arterial hypertension. The optimal level of blood pressure, which maintains sufficient renal blood flow in chronic renal failure and does not induce hyperfiltration, varies within 130/80-85 mm Hg. in the absence of severe coronary or cerebral atherosclerosis. At an even lower level - 125/75 mm Hg. it is necessary to maintain blood pressure in patients with chronic renal failure with proteinuria exceeding 1 g / day. At any stage of chronic renal failure, ganglionic blockers are contraindicated; guanethidine, systematic use of sodium nitroprusside, diazoxide is inappropriate. Saluretics, ACE inhibitors, angiotensin II receptor blockers, beta-blockers, and centrally acting drugs are most suitable for the tasks of antihypertensive therapy in the conservative stage of chronic renal failure.

Centrally acting drugs

Centrally acting drugs reduce blood pressure by stimulating adrenoreceptors and imidazoline receptors in the central nervous system, which leads to blockade of peripheral sympathetic innervation. Clonidine and methyldopa are poorly tolerated by many patients with chronic renal failure due to worsening depression, induction of orthostatic and intradialytic hypotension. In addition, the participation of the kidneys in the metabolism of these drugs dictates the need for dosage adjustment in chronic renal failure. Clonidine is used to stop a hypertensive crisis in chronic renal failure, blocks diarrhea in autonomic uremic neuropathy of the gastrointestinal tract. Moxonidine, unlike clonidine, has a cardioprotective and antiproteinuric effect, less central (depressive) effect and enhances the hypotensive effect of drugs from other groups without disturbing the stability of central hemodynamics. The dosage of moxonidine must be reduced as chronic renal failure progresses, since 90% of the drug is excreted by the kidneys.

Saluretics

Saluretics normalize blood pressure by correcting hypervolemia and removing excess sodium. Spironolactone, used in the initial stage of chronic renal failure, has a nephroprotective and cardioprotective effect by counteracting uremic hyperaldosteronism. With CF less than 50 ml/min, loop and thiazide-like diuretics are more effective and safe. They increase the excretion of potassium, are metabolized by the liver, therefore, in chronic renal failure, their dosages are not changed. Of the thiazide-like diuretics in chronic renal failure, indapamide is the most promising. Indapamide controls hypertension both by diuretic action and by vasodilation - by reducing round vascular resistance. In severe chronic renal failure (EC less than 30 ml / min), the combination of indapamide with furosemide is effective. Thiazide-like diuretics prolong the natriuretic effect of loop diuretics. In addition, due to the inhibition of hypercalciuria caused by loop diuretics, indapamide corrects hypocalcemia and thereby slows down the formation of uremic hyperparathyroidism. However, saluretics are not used for monotherapy of hypertension in chronic renal failure, since with prolonged use they exacerbate hyperuricemia, insulin resistance, and hyperlipidemia. On the other hand, saluretics enhance the hypotensive effect of central antihypertensive agents, beta-blockers, ACE inhibitors and ensure the safety of spironolactone in the initial stage of chronic renal failure - due to potassium excretion. Therefore, it is more beneficial to periodically (1-2 times a week) prescribe saluretics against the background of the constant intake of these groups of antihypertensive drugs. Due to the high risk of hyperkalemia, spironolactone is contraindicated in patients with diabetic nephropathy in the initial stage of chronic renal failure, and in patients with non-diabetic nephropathy - with CF less than 50 ml / min. Patients with diabetic nephropathy are recommended loop diuretics, indapamide, xipamide. In the political stage of chronic renal failure, the use of loop diuretics without adequate control of water and electrolyte balance often leads to dehydration with acute chronic renal failure, hyponatremia, hypokalemia, hypocalcemia, disorders heart rate and tetany. Loop diuretics also cause severe vestibular disorders. Ototoxicity increases dramatically when saluretics are combined with aminoglycoside antibiotics or cephalosporins. In hypertension associated with cyclosporine nephropathy, loop diuretics may exacerbate and spironolactone may reduce ciclosporin nephrotoxicity.

ACE inhibitors and angiotensin II receptor blockers

ACE inhibitors and angiotensin II receptor blockers have the most pronounced nephro- and cardioprotective effect. Angiotensin II receptor blockers, saluretics, calcium channel blockers and statins enhance, and acetylsalicylic acid and NSAIDs weaken the hypotensive effect of ACE inhibitors. With poor tolerance of ACE inhibitors (excruciating cough, diarrhea, angioedema), they are replaced with angiotensin II receptor blockers (losartan, valsartan, eprosartan). Losartan has a uricosuric effect that corrects hyperuricemia. Eprosartan has the properties of a peripheral vasodilator. Long-acting drugs metabolized in the liver and therefore prescribed to patients with chronic renal failure in little changed doses are preferred: fosinopril, benazepril, spirapril, losartan, valsartan, eprosartan. Doses of enalapril, lisinopril, perindopril, cilazapril should be reduced in accordance with the degree of reduction in CF; they are contraindicated in ischemic kidney disease, severe nephroangiosclerosis, hyperkalemia, terminal chronic renal failure (blood creatinine more than 6 mg / dl), and also after transplantation - with hypertension caused by cyclosporine nephrotoxicity. The appointment of ACE inhibitors in conditions of severe dehydration (against the background of prolonged use of large doses of saluretics) leads to prerenal acute renal failure. In addition, ACE inhibitors sometimes reduce the antianemic effect of epoetin preparations.

Calcium channel blockers

The advantages of calcium channel blockers include a cardioprotective effect with inhibition of coronary artery calcification, a normalizing effect on the circadian rhythm of atrial pressure in chronic renal failure, and the absence of Na and uric acid retention. At the same time, due to the negative inotropic effect, it is not recommended to use calcium channel blockers in chronic heart failure. In hypertension and cyclosporine nephrotoxicity, their ability to influence afferent vasoconstriction and inhibit glomerular hypertrophy is useful. Most drugs (with the exception of isradipine, verapamil, nifedipine) are used in chronic renal failure in normal doses due to a predominantly hepatic type of metabolism. Calcium channel blockers of the dihydropyridine series (nifedipine, amlodipine, isradipine, felodipine) reduce the production of endothelin-1, however, compared to ACE inhibitors, they have less effect on impaired glomerular autoregulation, proteinuria, and other mechanisms of progression of chronic renal failure. Therefore, in the conservative stage of chronic renal failure, dihydropyridine calcium channel blockers should be used in combination with ACE inhibitors or angiotensin II receptor blockers. For monotherapy, verapamil or diltiazem are more suitable, which are distinguished by a distinct nephroprotective and antianginal effect. These drugs, as well as felodipine, are most effective and safe in the treatment of hypertension in acute and chronic ciclosporin and tacrolimus nephrotoxicity. They also have an immunomodulating, normalizing phagocytosis effect.

Antihypertensive therapy of renal hypertension depending on the etiology and clinical features of chronic renal failure

Beta-blockers, peripheral vasodilators

Beta-blockers, peripheral vasodilators are used in severe renin-dependent renal hypertension with contraindications to the use of ACE inhibitors and angiotensin II receptor blockers. Most beta-blockers, as well as carvedilol, prazosin, doxazosin, terazolin, are prescribed for chronic renal failure in usual dosages, and propranolol is used to stop a hypertensive crisis even at dosages much higher than the average therapeutic ones. Dosages of atenolol, acebutolol, nadolol, betaxolol, hydralazine must be reduced, since their pharmacokinetics are impaired in chronic renal failure. Beta-blockers have a pronounced antianginal and antiarrhythmic effect, so they are used to treat hypertension in patients with chronic renal failure complicated by coronary artery disease, supraventricular arrhythmias. For systematic use in chronic renal failure, beta-selective drugs (atenolol, betaxolol, metoprolol, bisoprolol) are indicated. In diabetic nephropathy, nebivolol and carvedilol are preferred, having little effect on carbohydrate metabolism, normalizing the circadian rhythm of blood pressure and NO synthesis in the endothelium. Metoprolol, bisoprolol and carvedilol effectively protect the myocardium from the effects of increased sympathetic tone and catecholamines. With severe uremic cardiomyopathy (ejection fraction less than 30%), they reduce cardiac mortality by 30%. When prescribing alpha1-blockers (doxazosin, alfuzosin, terazosin), it should be borne in mind that, along with the hypotensive effect, they delay the development of benign prostatic hyperplasia.

Contraindications to the use of beta-blockers, in addition to the well-known ones (severe bradycardia, impaired atrioventricular conduction, unstable diabetes mellitus), in chronic renal failure include hyperkalemia, decompensated metabolic acidosis, and severe uremic hyperparathyroidism, when the risk of calcification of the cardiac conduction system is high.

Immunosuppressive Therapy

Used in patients with primary and secondary nephritis.

In chronic renal failure, extrarenal systemic signs of secondary glomerulonephritis are often absent or do not reflect the activity of the renal process. Therefore, with a rapid increase in renal failure in patients with primary or secondary glomerulonephritis with normal kidney size, one should think about exacerbation of nephritis against the background of chronic renal failure. Detection of signs of severe exacerbation of glomerulonephritis during kidney biopsy requires active immunosuppressive therapy. Doses of cyclophosphamide should be adjusted in chronic renal failure. Glucocorticosteroids and cyclosporine, metabolized mainly by the liver, should also be prescribed in chronic renal failure in reduced doses due to the risk of exacerbating hypertension and intrarenal hemodynamic disorders.

Anemia treatment

Since neither a low-protein diet nor antihypertensive drugs correct renal anemia (ACE inhibitors sometimes exacerbate it), the administration of epoetin drugs in the conservative stage of chronic renal failure is often necessary. Indications for treatment with epoetin. In the conservative stage of chronic renal failure, epoetin is administered subcutaneously at a dose of 20-100 IU/kg once a week. One should strive for a complete early correction of anemia (Ht more than 40%, Hb 125-130 g/l). Iron deficiency that develops during epoetin therapy in the conservative stage of chronic renal failure is usually corrected by oral administration of iron fumarate or iron sulfate along with ascorbic acid. Eliminating anemia, epoetin has a pronounced cardioprotective effect, slowing down left ventricular hypertrophy and reducing myocardial ischemia in IHD. Epoetin normalizes appetite, enhances the synthesis of albumin in the liver. This increases the binding of drugs to albumin, which normalizes their action in chronic renal failure. But with malnutrition, hypoalbuminemia, resistance to antianemic and other drugs can develop, so a quick correction of these disorders with essential keto / amino acids is recommended. Under the condition of complete control of hypertension, epoetin has a nephroprotective effect by reducing renal ischemia and normalizing cardiac output. With insufficient control of blood pressure, epoetin-induced hypertension accelerates the rate of progression of chronic renal failure. With the development of relative resistance to epoetin caused by ACE inhibitors or angiotensin II receptor blockers, treatment tactics should be chosen individually. If ACE inhibitors are used to correct arterial hypertension, it is advisable to replace them with calcium channel blockers or beta-blockers. In the event that ACE inhibitors (or angiotensin II receptor blockers) are used to treat diabetic nephropathy or uremic cardiomyopathy, treatment is continued with an increase in the dose of epoetin.

Treatment of infectious complications

For acute pneumonia and infection urinary tract semi-synthetic penicillins or cephalosporins of the II-III generation are preferred, providing a bactericidal concentration in the blood and urine, characterized by moderate toxicity. It is possible to use macrolides (erythromycin, azithromycin, clarithromycin), rifampicin and synthetic tetracyclines (doxycycline), which are metabolized by the liver and do not require significant dose adjustment. In polycystic disease with infection of cysts, only lipophilic drugs (chloramphenicol, macrolides, doxycycline, fluoroquinolones, clindamycin, co-trimoxazole) administered parenterally are used. In generalized infections caused by opportunistic (more often gram-negative) flora, drugs from the group of fluoroquinolones or aminoglycoside antibiotics (gentamicin, tobramycin) are used, which are characterized by high general and nephrotoxicity. Doses of these drugs, metabolized by the kidneys, must be reduced in accordance with the severity of chronic renal failure, and the timing of their use should be limited to 7-10 days. Dosage adjustment is necessary for many antiviral (acyclovir, ganciclovir, ribavirin) and antifungal (amphotericin B, fluconazole) drugs.

The treatment of chronic renal failure is a very complex process and requires the involvement of doctors from many specialties.

The filtration capacity of the kidneys depends on the value of blood pressure, its level determines the life expectancy of patients with renal failure. Urine excretion stops when the systolic rate is below 80 mm Hg. Art., and hypertension contributes to the destruction of renal tissue.

Hypertension is the most common form of disorders in chronic kidney failure. It usually develops even before renal dysfunction, and with its onset, it is detected in almost 90% of patients. High blood pressure is accompanied by glomerulonephritis, pyelonephritis, amyloidosis and polycystic kidney disease, it is often found in diabetic nephropathy.

Hypertension itself leads to kidney damage. It has been proven that even a moderate increase in performance over several years leads to the destruction of nephrons. With ineffective treatment, this leads to severe and even end-stage renal failure.

Arterial hypertension is regarded as an unfavorable factor affecting not only the rapid progression of impaired blood purification by the kidneys, but also reduces the life expectancy of patients.

treatment of renal hypertension

From it you will learn about the danger of the disease, its diagnosis, treatment tactics, possible complications and features of prevention.

Read more about diuretics for high blood pressure here.

Low

Hypotonic reactions in acute renal failure may be associated with a drop in cardiac output during shock, a sharp decrease in circulating blood volume during dehydration. They often occur with an overdose of antihypertensive drugs. But the most common cause of low blood pressure is hemodialysis. Hypotension in patients appears when:

• high speed or large volume filtration;
• with heart failure;
• long-term dialysis (more than 5 years);
• excessive activation of the parasympathetic system (reflex reaction to blood cleansing).

The danger of hypotension is to reduce the nutrition of the kidneys, heart and brain. This can be deadly, especially for older patients due to acute circulatory disorders.

Treatment of hemodialysis hypotension requires the correct selection of the regimen of the procedure, with a sharp decrease, Dobutamine can be introduced.

Even with timely detection of arterial hypertension and regular intake of antihypertensive drugs, it is possible to achieve protection of kidney tissue in only 10-15% of patients. The lowest therapy success rates were observed for obesity, diet neglect and smoking. The level of blood pressure that should be aimed at to slow the progression of kidney failure (target) depends on the degree of protein loss in the urine.

The very appearance of proteinuria is a risk factor for high blood pressure. Even with normal values, after the detection of protein in the urine, hypertension soon develops. In the absence of albuminuria, the generally accepted level of 140/90 mm Hg is considered normal. Art., if it is below 1 g per day, then 130/85 units, and at higher values ​​- 125/80. At the same time, the deterioration of blood flow in the kidneys begins to develop at systolic pressure below 115 mm Hg. Art.

For older people with advanced atherosclerosis, individual target values ​​are set, taking into account possible complications. A sharp decrease or fluctuations in hemodynamic parameters often lead to stroke and myocardial infarction.

Watch the video about the causes of high blood pressure of renal origin:

The development of arterial hypertension in violation of the kidneys is associated with several reasons:

• activation of the formation of renin and the launch of a chain of its transformations into angiotensin 2;
• increased levels of aldosterone;
• increased release of adrenaline and increased tone of the sympathetic nervous system;
• water and sodium retention;
• dysfunction of baroreceptors (react to pressure) and chemoreceptors (perceive changes in blood composition);
• acceleration of the formation of vasoconstrictor substances;
• anemia, drugs for its treatment (erythropoietin);
• volume overload when creating an arteriovenous fistula for dialysis.

It should be borne in mind that a third of patients had arterial hypertension even before the onset of chronic renal failure due to kidney disease or hypertension complicated by nephropathy.

In patients with impaired renal function, drugs to treat hypertension should address the underlying causes of hypertension. It is important that their use does not reduce renal blood flow and urine filtration. Essential requirements also include minimal impact on metabolic processes and minor side effects.

Loop diuretics are used to remove excess sodium and water. Most often it is Lasix or Uregit. They increase the filtration capacity of the kidneys and excrete potassium, which is greatly increased in renal failure. For the same reason (hyperkalemia), Veroshpiron, Triampur and Moduretik are not recommended. Thiazide drugs (Hypothiazid, Oxodoline) are contraindicated in patients with reduced kidney function.

One of the most prescribed groups for lowering blood pressure. They have such advantages:

• improve blood circulation in the kidneys;
• do not retain sodium;
• protect kidney tissue from destruction;
• normalize not only systemic, but also intraglomerular pressure;
• reduce protein loss;
• slow down the progression of renal failure;
• do not change lipid metabolism.

For treatment use: Corinfar, Lomir, Nicardipine, Diacordin retard.

They have advantages in the initial stages of renal failure, but are potentially dangerous during the use of diuretics or hemodialysis. May cause an increase in potassium in the blood, a deterioration in creatinine levels, an increase in the loss of protein in the urine, severe allergic reactions. Usually they are not used for monotherapy, but are included in complex treatment in small doses.

Angiotensin II receptor blockers have similar pharmacological effects, they prevent the vasoconstrictor action of this compound, but do not impair renal function. To the most effective drugs include: Lorista, Vazar, Aprovel.

In severe hypertension against the background of a high level of renin in the blood, large doses of adrenoceptor blockers are recommended.

Both beta-blockers (Concor, Lokren) and combined alpha and beta antiadrenergic drugs (Carvedilol, Lacardia) can be used. They are used with caution in the development of heart failure, as they can reduce cardiac output.

If necessary, the appointment is combined with cardiac glycosides under the control of potassium levels in the blood.

A single drug rarely achieves a stable reduction in blood pressure in patients with kidney disease. Increasing the dose in renal failure can be dangerous. Therefore, the best option is a combination of drugs. Combinations that work well:

• Corinfar + Dopegit + Sotalol;
• Tritace + Lasix + Coriol;
• Diacordin + Concor + Kamiren.

To effectively control blood pressure and kidney function, patients require special nutrition. The basic principles of compiling a diet for renal failure:

• reduction in protein intake to 0.7 g per 1 kg of body weight at the initial stage, then it is limited to 20 g per day;
• all the necessary protein should come from lean meat, cottage cheese, eggs and fish;
• due to the high tendency to atherosclerosis, animal fat is replaced with vegetable fat, seafood is recommended;
• to calculate the drinking ration, daily diuresis is measured and 500 ml is added to it;
• in the absence of edema, table salt in the amount of 3-5 g is given to the hands for salting, and prepared without it, if there are edema and persistent hypertension, then reduce to 1-2 g per day.

If high blood pressure remains on the background of the diet and the use of combined antihypertensive therapy, then sodium is removed by blood filtration (hemofiltration, dialysis). Patients who are scheduled for a kidney transplant and whose blood pressure remains critically high have two kidneys removed and undergo regular hemodialysis sessions prior to transplantation.

atherosclerosis of the renal arteries

From it you will learn about the causes of the development and classification of the disease, the symptoms of the pathology, the danger of the condition, methods of diagnosis and treatment.

Learn more about hypertension testing here.

The kidneys are the organ that regulates blood pressure. In renal failure, arterial hypertension most often occurs. If it cannot be corrected, then the signs of impaired urine filtration progress, and the life expectancy of patients is reduced. H

low pressure is less common, for its correction it is necessary to eliminate the cause (shock, dehydration, overdose of antihypertensive drugs). Hypertension therapy includes different groups of drugs, their combinations, dietary nutrition and non-drug methods of blood filtration.

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.

In 10% of patients with high blood pressure Renal arterial hypertension was diagnosed. It is characteristic of nephrosclerosis, pyelonephritis, glomerulonephritis, and other renal diseases. Most often it affects men aged 30 to 50 years.

Renal hypertension #8211; secondary arterial hypertension arising 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 irritations and transmit them 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 copious excretion hormones of the adrenal cortex, there is a delay of sodium and water. The tone of the renal vessels increases, their sclerosis occurs: soft deposits accumulate in the form of 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

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 with periarteritis nodosa, with symptoms of impaired renal function combined with clinical signs 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

Kidney disease #8211; common cause of high blood pressure. Therapy of hypertension of renal genesis is carried out by cardiologists and nephrologists. Preservation of kidney function #8211; 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.

The progressive method #8211 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 #8211; important outcomes of surgery.

timely effective therapy renal hypertension #8211; the key to a quick and successful remission.

Renal hypertension is secondary arterial hypertension due to organic diseases kidneys. Distinguish renal hypertension associated with diffuse lesions of the kidneys, and renovascular hypertension.

Renal hypertension associated with diffuse kidney damage often develops in chronic pyelonephritis, chronic and acute glomerulonephritis, kidney damage in systemic vasculitis, diabetic nephropathy, polycystic kidney disease, less often in interstitial lesions and amyloidosis; for the first time may occur as a sign of chronic renal failure. Renal hypertension develops due to sodium and water retention, activation of pressor systems (reninangiotensin in 20% of cases and sympathetic-adrenal systems), with a decrease in the function of the depressor system of the kidneys (renal prostaglandins). Vasorenal hypertension is caused by narrowing of the renal arteries, it accounts for 2-5% of all forms of arterial hypertension, narrowing of the renal artery by atherosclerotic plaque or fibromuscular hyperplasia of the artery, less often aortoarteritis, renal artery aneurysm.

Symptoms of renal hypertension

Signs of arterial hypertension in kidney diseases are determined by the degree of increase in blood pressure, the severity of damage to the heart and blood vessels, and the initial state of the kidneys. The severity of hypertension ranges from mild labile hypertension to malignant hypertension. Complaints of patients: fatigue, irritability, palpitations, less often - headache. In malignant hypertensive syndrome, there is persistent high blood pressure, severe retinopathy with foci of hemorrhages, edema of the optic nerve head, plasmorrhagia, sometimes with reduced vision to blindness, hypertensive encephalopathy, heart failure (initially left ventricular, then with blood stasis in big circle circulation). Anemia contributes to the development of heart failure in CRF. Hypertensive crises in kidney diseases are relatively rare and are manifested by a sharp headache, nausea, vomiting, visual impairment. Compared with hypertension, complications of hypertension (stroke, mycardial infarction) in nephropathies are less common. The development of hypertension worsens the prognosis of kidney disease.

Arterial hypertension may be a leading sign of nephropathy (hypertensive variant chronic glomerulonephritis); the combination of hypertension with severe nephrotic syndrome is characteristic of rapidly progressive subacute glomerulonephritis. In patients with chronic pyelonephritis, hypertensive syndrome occurs against the background of severe hypokalemia, bacteriuria is often detected. Malignant hypertension is most common in patients with systemic diseases - periarteritis nodosa and systemic scleroderma.

At differential diagnosis nephrogenic hypertension and hypertension take into account that in patients with renal hypertension, changes in urine are detected before an increase in blood pressure is detected, edematous syndrome often develops, vegetative-neurotic disorders are less pronounced, the course of hypertension is less often complicated by hypertensive crises, myocardial infarction, stroke. In the diagnosis of vasorenal hypertension, instrumental studies, the study of renin activity in peripheral veins and renal veins, and listening to systolic murmur in the projection of the renal arteries are of great importance.

Treatment of renal hypertension

Drug therapy of hypertensive syndrome should be carried out with restriction of salt intake to 3-4 g per day; taking any drug begins with small doses; therapy should be combined; therapy should be prescribed with one drug, adding others sequentially; if renal hypertensive syndrome exists for more than 2 years, treatment should be continuous; with severe renal insufficiency, diastolic blood pressure should not be reduced below 90 mm Hg. Art.

When conducting antihypertensive therapy, the severity of renal failure should be assessed, the drugs of choice are those that improve kidney function; in terminal renal failure (glomerular filtration less than 15 ml / min), blood pressure is corrected using chronic dialysis, with refractoriness to ongoing therapy for hypertension, kidney removal followed by transplantation is indicated.

Arterial hypertension can be secondary, and result from impaired renal function.

High blood pressure, hypertension or arterial hypertension - there is hardly a person who has not heard of such a problem. The main feature of this pathology is a steady increase blood pressure. Usually we associate this behavior of the body with problems of the cardiovascular system, and in most cases this is exactly the case. But there are other reasons for high blood pressure, one of them is a violation of the kidneys. In this case, we speak of renal hypertension.

Renal hypertension is understood as secondary arterial hypertension caused by disorders in the functioning of the kidneys. According to statistics, renal hypertension (HR) is 5% of the total number of people suffering from arterial hypertension.

Usually in the development of hypertension, we "blame" the cardiovascular system. But blood pressure indicators also depend on the work of the kidneys, because the kidneys regulate the amount of fluid in the blood, are responsible for the level of sodium ions and control the special hormonal system responsible for blood pressure indicators.

If blood pressure drops, the kidneys are able to restore it by “signaling” the body to conserve water and salt in the body while constricting blood vessels. Malfunctions in this mechanism can cause the body to begin to increase blood pressure at the wrong time, which can lead to hypertension.

Renal hypertension, depending on the causes of its occurrence, is divided into two varieties:

• diffuse, caused by kidney damage
• renal vascular or renovascular

This type of renal hypertension occurs due to damage to the tissues of the kidneys, which in turn occurs against the background of various diseases. Diseases that provoke the development of PG include:

• chronic pyelonephritis
• chronic and acute glomerulonephritis
• systemic vasculitis
• diabetic nephropathy
• polycystic kidney disease

Rhinovascular hypertension develops with narrowing of the lumen of the renal arteries and their branches. . Rhinovascular hypertension occurs less frequently than diffuse renal hypertension.

The main symptom of renal hypertension, as in other variations of hypertension, is a steady increase in blood pressure. But in this symptom, renal hypertension has a characteristic feature - an increase in the lower indicator (diastolic pressure).

Other symptoms include:

Renal hypertension, in contrast to the "normal" less often leads to the development of hypertensive crises, heart attacks and strokes. But at the same time, renal hypertension can be quite difficult and difficult to treat.

To accurately determine the presence of renal hypertension, it is necessary to conduct a series of diagnostic studies.

High blood pressure 2-4 times increases the risk of brain cancer, an international group of scientists concluded

A urinalysis can show a problem even before a sustained rise in blood pressure. Therefore, it is done in the first place, where they pay attention to the presence of protein, the level of leukocytes, erythrocytes and cylinders.

Ultrasound of the kidneys is also done - this will help to identify changes in their size and other physiological disorders. In addition, kidney scanning, urography and radioisotope radiography are used.

A comprehensive examination allows you to accurately determine the type of hypertension, after which it is time to proceed to treatment.

The relationship between blood pressure and kidney disease is complex. The kidneys can simultaneously cause the development of hypertension and be its target. Sustained hypertension contributes to the deterioration of kidney disease and provokes the development of kidney failure. Therefore, the treatment of renal hypertension should be aimed simultaneously at normalizing pressure and improving the condition of the kidneys.

Many drugs used for kidney disease can change blood pressure readings. Therefore, the doctor must be very careful about the selection of drugs.

With renal hypertension, it is dangerous to self-medicate and drink diuretics or any other drugs that “should help” uncontrollably. It is necessary to strictly follow the doctor's prescription and use only prescribed drugs in the indicated doses.

In some cases, in particular, if the cause of hypertension is a narrowing of the renal artery, an operation may be recommended that will eliminate the vessel defect, and thereby normalize the state of the body.

In renal hypertension, it is very important to pay attention on a diet. First of all, you need to limit the amount of salt in food, as well as exclude spicy and smoked foods from the menu. People with kidney problems and hypertension are also advised to limit their fluid intake.

Keep an eye on your blood pressure, don't let it spike, take care of your kidneys and be healthy!

DIC in kidney disease

Testosterone and the prostate

Sources:
No comments yet!

Stably high blood pressure against the background of various kidney diseases is a dangerous condition for both health and life, and requires immediate medical attention. Early diagnosis of renal hypertension and determination of the optimal timely course of treatment will help to avoid many negative consequences.

Renal hypertension (renal pressure, renal hypertension) belongs to the group of symptomatic (secondary) hypertension. This type of arterial hypertension develops as a result of certain kidney diseases. It is important to correctly diagnose the disease and take all necessary medical measures in time to prevent complications.

Disease prevalence

Renal hypertension is diagnosed in about 5-10 cases out of every 100 in patients who have evidence of stable hypertension.

Like another type of disease, this pathology is accompanied by a significant increase in blood pressure (starting from 140/90 mm Hg. Art.)

Additional signs:

• Stable high diastolic pressure.
• No age restrictions.
• High risk of acquiring malignant hypertension.
• Difficulties in treatment.

For practical use in medicine, a convenient classification of the disease has been developed.

Reference. Since hypertension is a very diverse pathology, it is customary to use disease classifications that take into account one or a group of existing criteria. Diagnosing a specific type of disease is a top priority. Without such actions, it is generally not possible to choose a competent correct tactics of therapy and designate preventive measures. Therefore, doctors determine the type of hypertension according to the causes that caused the disease, according to the characteristics of the course, specific blood pressure indicators, possible damage to the target organ, the presence of hypertensive crises, as well as the diagnosis of primary or essential hypertension, which is allocated to a separate group.

It is impossible to determine the type of disease on your own! Contacting a specialist and undergoing complex comprehensive examinations are mandatory for all patients.

Treatment with home methods in case of any manifestation of an increase in blood pressure (episodic, and even more so regular) is unacceptable!

Renal hypertension. Principles of disease classification

Group of renoparenchymal hypertension

The disease is formed as a complication of certain types of functional renal disorders. We are talking about unilateral or bilateral diffuse damage to the tissues of this important organ.

List of renal lesions that can cause renal hypertension:

• Inflammation of some areas of the kidney tissue.
• Polycystic kidney disease, as well as other congenital forms of their anomalies.
• Diabetic glomerulosclerosis as a severe form of microangiopathy.
• A dangerous inflammatory process with localization in the glomerular renal apparatus.
• Infectious lesion (tuberculous nature).
• Some diffuse pathologies proceeding according to the type of glomerulonephritis.

The cause of the parenchymal type of hypertension in some cases are also:

• inflammatory processes in the ureters or in the urethra;
• stones (in the kidneys and urinary tract);
• autoimmune damage to the renal glomeruli;
• mechanical obstacles (due to the presence of neoplasms, cysts and adhesions in patients).

Pathology is formed due to certain lesions in one or two renal arteries. The disease is considered rare. Statistics confirms only one case of renovascular hypertension out of a hundred manifestations of arterial hypertension.

Provoking factors

You should be wary of:

• atherosclerotic lesions with localization in the renal vessels (the most common manifestations in this group of pathologies);
• fibromuscular hyperplasia of the renal arteries;
• anomalies in the renal arteries;
• mechanical compression

As the immediate cause of the development of this type of disease, doctors often diagnose:

• nephroptosis;
• tumors;
• cysts;
• congenital anomalies in the kidneys themselves or vessels in this organ.

Pathology manifests itself as a negative synergistic effect from a combination of damage to the tissues and vessels of the kidneys.

Group of mixed renal hypertension

Conditions for the development of renal pressure

Studying the process of development of various types of renal hypertension, scientists have identified three main factors of influence, these are:

• insufficient excretion of sodium ions by the kidneys, leading to water retention;
• the process of suppression of the depressor system of the kidneys;
• activation of the hormonal system that regulates blood pressure and blood volume in the vessels.

The pathogenesis of renal hypertension

Problems arise when there is a significant decrease in renal blood flow and reduced glomerular filtration efficiency. This is possible due to the fact that diffuse changes in the parenchyma occur or the blood vessels of the kidneys are affected.

How do the kidneys react to the process of reducing blood flow in them?

1. There is an increase in the level of reabsorption (reabsorption process) of sodium, which then causes the same process in relation to the liquid.
2. But pathological processes are not limited to sodium and water retention. Extracellular fluid begins to increase in volume and compensatory hypervolemia (a condition in which blood volume increases due to plasma).
3. A further development scheme includes an increase in the amount of sodium in the walls of blood vessels, which, as a result, swell, while showing increased sensitivity to angiotensin and aldosterone (hormones, regulators of water-salt metabolism).

We should also mention the activation of the hormonal system, which becomes an important link in the development of renal hypertension.

The mechanism of increasing blood pressure

The kidneys secrete a special enzyme called renin. This enzyme promotes the transformation of angiotensinogen into angiotensin I, from which, in turn, angiotensin II is formed, which constricts blood vessels and increases blood pressure. .

Development of renal hypertension

Consequences

The algorithm for increasing blood pressure described above is accompanied by a gradual decrease in the compensatory capabilities of the kidneys, which were previously aimed at lowering blood pressure if necessary. For this, the release of prostaglandins (hormone-like substances) and KKS (kallikrein-kinin system) was activated.

Based on the foregoing, an important conclusion can be drawn - renal hypertension develops according to the principle of a vicious circle. At the same time, a number of pathogenic factors lead to renal hypertension with a persistent increase in blood pressure.

Renal hypertension. Symptoms

When diagnosing renal hypertension, one should take into account the specifics of such concomitant diseases as:

• pyelonephritis;
• glomerulonephritis;
• diabetes.

Also pay attention to a number of such frequent complaints of patients, such as:

• pain and discomfort in the lower back;
• problems with urination, increased volume of urine;
• periodic and short-term increase in body temperature;
• persistent feeling of thirst;
• feeling of constant weakness, loss of strength;
• swelling of the face;
• gross hematuria (visible admixture of blood in the urine);
• fast fatiguability.

In the presence of renal hypertension in the urine of patients often found (during laboratory tests):

• bacteriuria;
• proteinuria;
• microhematuria.

Typical features of the clinical picture of renal hypertension

The clinical picture depends on:

• from specific indicators of blood pressure;
• functional abilities of the kidneys;
• the presence or absence of concomitant diseases and complications affecting the heart, blood vessels, brain, etc.

Renal hypertension is invariably accompanied by a constant increase in the level of blood pressure (with the dominance of an increase in diastolic pressure).

Patients should be seriously wary of the development of malignant hypertensive syndrome, accompanied by spasm of arterioles and an increase in total peripheral vascular resistance.

The diagnosis is based on taking into account the symptoms of concomitant diseases and complications. For the purpose of differential analysis, laboratory research methods are mandatory.

Renal hypertension and its diagnosis

The patient may be given:

• OAM (general urinalysis);
• urinalysis according to Nechiporenko;
• urinalysis according to Zimnitsky;
• Ultrasound of the kidneys;
• bacterioscopy of urinary sediment;
• excretory urography (X-ray method);
• scanning of the kidney area;
• radioisotope renography (X-ray examination using a radioisotope marker);
• kidney biopsy.

The conclusion is drawn up by the doctor based on the results of the patient's questioning (history taking), his external examination and all laboratory and hardware studies.

The course of treatment of renal hypertension must necessarily include a number of medical measures to normalize blood pressure. At the same time, pathogenetic therapy is carried out (the task is to correct the impaired functions of organs) of the underlying pathology.

One of the main conditions for effective assistance to nephrological patients is a salt-free diet.

The amount of salt in the diet should be kept to a minimum. And for some kidney diseases, a complete rejection of salt is recommended.

Attention! The patient should not consume salt more than the allowed norm of five grams per day. Keep in mind that sodium is also found in most foods, including their flour products, sausages, and canned food, so salting cooked food will have to be abandoned altogether.

Treatment of renal hypertension

In what cases is a tolerant salt regime allowed?

A slight increase in sodium intake is allowed for those patients who are prescribed as a medicine. salturetics (thiazide and loop diuretics).

It is not necessary to severely restrict salt intake in symptomatic patients:

• polycystic kidney disease;
• salt-wasting pyelonephritis;
• some forms of chronic renal failure, in the absence of a barrier to sodium excretion.

Diuretics (diuretics)

Classification of modern diuretic drugs (diuretics) according to the features of the therapeutic effect

Note. To determine the individual salt regimen, the daily release of electrolytes is determined. It is also necessary to fix the volume indicators of blood circulation.

Studies conducted in the development of a variety of methods to reduce blood pressure in renal hypertension have shown:

1. A sharp decrease in blood pressure is unacceptable due to the significant risk of impaired renal function. The baseline must not be lowered more than one quarter at a time.
2. Treatment of hypertensive patients with the presence of pathologies in the kidneys should be aimed primarily at lowering blood pressure to an acceptable level, even against the background of a temporary decrease in kidney function. It is important to eliminate the systemic conditions for hypertension and non-immune factors that worsen the dynamics of renal failure. The second stage of treatment is medical assistance aimed at strengthening renal functions.
3. Arterial hypertension in a mild form suggests the need for stable antihypertensive therapy, which is aimed at creating positive hemodynamics and creating barriers to the development of renal failure.

The patient may be prescribed a course of thiazide diuretics, in combination with a number of adrenergic blockers.

Several different antihypertensive drugs are approved for the treatment of nephrogenic arterial hypertension.

Pathology is treated:

• angiotensin-converting enzyme inhibitors;
• calcium antagonists;
• b-blockers;
• diuretics;
• a-blockers.

Medicines to lower blood pressure in kidney failure

The treatment process must comply with the principles:

• continuity;
• long duration in time;
• dietary restrictions (special diets).

Before prescribing specific drugs, it is imperative to determine how severe renal failure is (the level of glomerular filtration is being studied).

The patient is determined for long-term use of a specific type of antihypertensive drug (for example, dopegyt). This drug affects the brain structures that regulate blood pressure.

Duration of medication

End stage renal failure. Features of therapy

Chronic hemodialysis is required. The procedure is combined with antihypertensive treatment, which is based on the use of special medications.

Important. With the ineffectiveness of conservative treatment and the progression of renal failure, the only way out is transplantation of a donor kidney.

In order to prevent renal arterial genesis, it is important to follow simple, but effective, precautions:

• systematically measure blood pressure;
• at the first signs of hypertension, seek medical help;
• limit salt intake;
• to ensure that obesity does not develop;
• give up all bad habits;
• lead a healthy lifestyle;
• avoid hypothermia;
• pay enough attention to sports and exercise.

Preventive measures for renal hypertension

conclusions

Arterial hypertension is considered an insidious disease that can cause various complications. In combination with damage to the renal tissue or blood vessels, it becomes deadly. Careful adherence to preventive measures and consultation with medical specialists will help reduce the risk of pathology. Everything possible should be done to prevent the occurrence of renal hypertension, and not to deal with its consequences.

Kidney disease can cause secondary hypertension, which is called hypertension in renal failure. The peculiarity of this condition is that, along with nephropathy, the patient has high values ​​of systolic and diastolic pressure. Treatment of the disease is long. Arterial hypertension of any origin is one of the most common cardiovascular diseases and occupies 94-95% of them. The share of secondary hypertension accounts for 4-5%. Among secondary hypertension, renovascular hypertension is the most common and accounts for 3-4% of all cases.

The occurrence of arterial hypertension in chronic renal failure (chronic renal failure) is due to changes in the normal functioning of the organs of the urinary system, in violation of the mechanism of blood filtration. In this case, excess fluid and toxic substances (sodium salts and protein breakdown products) cease to be excreted from the body. Excess water accumulated in the extracellular space provokes the appearance of edema internal organs, arms, legs, face.

From a large amount of fluid, the renal receptors are irritated, the production of the enzyme renin, which breaks down proteins, increases. In this case, there is no increase in pressure, but interacting with other blood proteins, renin promotes the formation of angiotensin, which promotes the formation of aldosterone, which retains sodium. As a result, there is an increase in the tone of the renal arteries and the formation of cholesterol plaques, which narrow the cross section of blood vessels, is accelerated.

In parallel, the content of derivatives of polyunsaturated fatty acids and bradykinin, which reduce the elasticity of blood vessels, decreases in the kidneys. As a result, in hypertension of renovascular origin, high blood pressure is persistent. Hemodynamic disorder leads to cardiomyopathy (left ventricular hypertrophy) or other pathological conditions of cardio-vascular system.