肾实质性高血压

急、慢性肾小球肾炎、糖尿病肾病、慢性肾盂肾炎、多囊肾、肾移植后等多种肾脏病变引起的高血压。英文名：发病部位：心血管系统肾脏就诊科室：心血管内科症状：头晕头痛恶心和呕吐多发人群：老年治疗手段：药物康复疗法并发疾病：肾功能不全是否遗传：否是否传染：否

症状<!--[ifgtemso9]><xml><w:WordDocument><w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel><w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery><w:DisplayVerticalDrawingGridEvery>2</w:DisplayVerticalDrawingGridEvery><w:DocumentKind>DocumentNotSpecified</w:DocumentKind><w:DrawingGridVerticalSpacing>7.8磅</w:DrawingGridVerticalSpacing><w:PunctuationKerning></w:PunctuationKerning><w:View>Normal</w:View><w:Compatibility><w:DontGrowAutofit></w:DontGrowAutofit><w:BalanceSingleByteDoubleByteWidth></w:BalanceSingleByteDoubleByteWidth><w:DoNotExpandShiftReturn></w:DoNotExpandShiftReturn><w:UseFELayout></w:UseFELayout></w:Compatibility><w:Zoom>0</w:Zoom></w:WordDocument></xml><![endif]--><pclass="MsoNormal"style="padding:0pt0pt0pt0pt;mso-pagination:widow-orphan;text-align:left;">常表现为高血压的一般症状：头晕、头痛、心慌、乏力，伴有肾功能损害的症状：蛋白尿、血尿、贫血等<!--[ifgtemso9]><xml><w:LatentStylesDefLockedState="false"DefUnhideWhenUsed="true"DefSemiHidden="true"DefQFormat="false"DefPriority="99"LatentStyleCount="260"><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="Normal"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading1"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading2"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading3"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading4"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading5"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading6"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading7"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading8"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="heading9"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index1"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index2"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index3"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index4"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index5"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index6"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index7"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index8"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="index9"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc1"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc2"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc3"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc4"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc5"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc6"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc7"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc8"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="toc9"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="NormalIndent"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="footnotetext"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="annotationtext"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="header"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="footer"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="indexheading"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="caption"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="tableoffigures"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="envelopeaddress"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="envelopereturn"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="footnotereference"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="annotationreference"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="linenumber"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="pagenumber"></w:LsdException><w:LsdExceptionLocked="false"Priority="99"SemiHidden="false"Name="endnotereferen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病因<pclass="placeholder">肾实质病变包括急、慢性肾小球肾炎、糖尿病肾病、慢性肾盂肾炎、多囊肾、肾移植后等多种肾脏病变，由于大量肾单位的丢失，导致水、钠潴留和细胞外容量增加，以及肾脏RAAS系统激活与排钠减少，高血压又进一步升高肾小球内囊压力，形成恶性循环，加重肾脏病变。

检查1、临床上难以将肾实质性高血压病与原发性高血压伴肾脏损害鉴别。2、常规检查会出现：蛋白尿、血尿、贫血、肌酐清除率降低、肾小球滤过功能降低。3、肾穿刺组织学检查可以有助于诊断

诊断<pclass="placeholder">肾实质病变极性肾小球肾炎，多见于青少年，有急性起病链球菌感染史，有发热、血尿、浮肿史，鉴别并不困难。慢性肾小球肾炎与原发性高血压伴肾功能损害者不易区别，但反复浮肿史、明显贫血、血浆蛋白低、蛋白尿出现早而血压升高相对轻、眼底病变不明显有利于慢性肾小球肾炎的诊断。糖尿病肾病，无论是1型或2型，均可发生肾损害而有高血压，肾小球硬化、肾小球毛细血管基膜增厚为主要的病理改变，早期肾功能正常，仅有微量白蛋白尿，血压也可能正常;病情发展，出现明显蛋白尿及肾功能不全时血压升高。<pclass="placeholder">明确的肾脏疾病史可有助于诊断

治疗<pclass="placeholder">1、严格限制盐摄入，每天＜3g<pclass="placeholder">2、联合降压药物治疗，将血压控制在130/80mmHg以下<pclass="placeholder">3、如果不存在使用禁忌，联合药物中包含ACEI类或ARB类药物可减少尿蛋白，延缓肾功能恶化。

预后<pclass="placeholder">可以出现高血压在多器官功能受损。多伴有肾功能损害。

预防<pclass="placeholder">1、积极寻找病因，治疗原发病<pclass="placeholder">2、积极控制血压

1、临床上难以将肾实质性高血压病与原发性高血压伴肾脏损害鉴别。