盐酸特拉唑嗪治疗慢性肾脏病合并高血压42例疗效观察

目的观察盐酸特拉唑嗪片对临床慢性肾脏病(chronic kidney disease,CKD)合并高血压患者常规降压药物使用后疗效仍欠佳的高血压的疗效。方法盐酸特拉唑嗪片首剂2mg,睡前口服,以后视血压逐渐增加剂量,最大剂量:8 mg/日,可以4 mg bid口服。4周为一疗程,同时设自身对照组对比。结果降压有效率85.7%,以降低舒张压为主。结论盐酸特拉唑嗪对慢性肾脏病合并高血压的降压疗效确切。     

高血压的诊断和治疗(下)——肾脏病临床选萃(15)

甲(进修医生):肾实质性高血压的降压治疗,有何特点? 教师:任何肾实质疾病,都可以有高血压,特别是慢性肾小球肾炎。一切慢性肾脏病均需很好地控制高血压,因高血压会加速肾损害。为了防止或延迟发生肾功能衰竭,治疗高血压是极其重要的一环。而     

肾性高血压治疗进展

高血压既是慢性肾脏病的始动因素,也是慢性肾脏病的进展因素,还是慢性肾脏病患者心血管并发症的高危因素.因此,对于肾脏病合并高血压必须积极治疗.根据病因和发病机制不同,肾性高血压又可分为肾实质性和肾血管性高血压,但无论何种原因、何种类型高血压,控制血压达标均是治疗关键所在.本文从肾性高血压最佳目标血压水平、生活方式的调整、不同亚型临床治疗方式的选择及进展作一介绍.     

肾穿刺患者高血压状况的横断面研究

目的：了解接受肾穿刺活组织检查患者高血压病的患病及治疗情况，以指导诊断和治疗。方法：回顾分析。肾穿刺患者的资料．对其高血压情况进行横断面研究。结果：肾穿刺患者．尤其是其中的慢性。肾病患者中的高血压发生率高，分别为54．9％和63．3%，肾实质性高血压发生率较高．在全部。肾穿刺患者和慢性。肾病患者中分别为25．9％和26．3％。各种急、慢性肾脏病几乎都可以伴发高血压。伴有高血压的患者尿蛋白排泄率和血清肌酐值高于不伴高血压的患者。高血压患者入院时血压低于14090mmHg的占14．2％，慢性。肾病伴高血压患者人院时血压不高于130／80mmHg的占7．0％。结论：高血压和。肾脏病常常互为因果，伴随发生。高血压是。肾脏病病情严重的表征之一。通过控制血压来延缓。肾脏病进展．临床上仍大有可为。     

人工智能在慢性肾脏病应用现状及展望CSCD

近年来,随着人口老龄化,高血压和糖尿病发病率逐渐增加,慢性肾脏病发生率也在逐年攀升[1]。截至2020年,世界肾脏指导委员会报道全球约10%成年人患慢性肾脏病,超过200万慢性肾脏病患者正在接受肾脏替代治疗或肾移植治疗,我国慢性肾脏病患病率为10.8%,患者人数超过1亿[2,3]。慢性肾脏病患者在就医过程中需要消耗大量的医疗资源,同时也会产生大量的医疗数据,从而增加医疗护理人员的工作量。     

高血压合并糖尿病患者关于降压药物的选择

高血压和糖尿病是老年的常见病。当高血压与糖尿病并存时，心血管病的危险性倍增，控制高血压能减慢糖尿病视网膜病变，糖尿病肾病等慢性并发症的进展，减少高血压肾病、脑血管病和心血管病等慢性并发症。所以，对高血压合并糖尿病患者采用合适降压药物治疗是一个重要问题，作者就高血压合并糖尿病患者降压治疗的目的，各种降压药物的评价简述如下。     

慢性肾脏病伴不安腿综合征的研究进展

不安腿综合征在慢性肾脏病患者中非常普遍,常可导致患者失眠、生活质量下降以及增加高血压、心血管疾病的发生。深入研究慢性肾脏病与不安腿综合征的关系及发病机制可能为治疗慢性肾脏病患者不安腿综合征提供新的治疗方案。本文就慢性肾脏病伴不安腿综合征的流行病学、发病机制、诊断标准以及治疗的最新研究进展进行论述。     

慢性肾脏病高血压的治疗

高血压与慢性肾脏病关系密切，高血压是慢性肾脏病的病因和严重合并症。两者互为因果，形成恶性循环。因此，慢性肾脏病高血压必须积极治疗，降低血压同时保护好肾脏。依照最新的2007ESH／ESC指南，慢性肾脏病高血压治疗的靶目标值为130／80mmHg；一线降压药为ACEI／ARB、利尿剂、CCB、β-受体阻滞剂，已证明ACEI／ARB比其他降压药对‘肾脏保护更强，故应为慢性肾脏病治疗的首选。     

氯沙坦治疗肾性高血压30例临床分析

高血压是慢性肾脏疾患的常见并发症 ,也是慢性肾脏病的主要原因之一 ,并且高血压也是影响血液透析患者发病率与死亡率的重要因素之一 ,对这些患者的临床研究显示 ,控制血压有助于延缓疾病的进展。我们于１９９９年４月至１９９９年１２月使用氯沙坦治疗３０例肾性高血压患者 ,疗程为１２周 ,发现氯沙坦降压效果明显 ,且对蛋白尿有不同程度的改善 ,而对肾功能无明显影响。材料与方法一、一般资料全部病例均为我院１９９９年４月至１９９９年１２月收治的Ｉ～ＩＩ级高血压患者 (按１９９９年世界卫生组织／国际高血压学会的标准 ) ,病因为原发…     

深圳盐田区成年人中慢性肾脏病的患病情况及危险因素分析

目的：分析盐田区居民慢性肾脏病的患病率以及危险因素。方法选取2012年5月至2013年1月盐田区18岁以上的常住居民831例,进行问卷、体格检查和实验室检查,对慢性肾脏病的患病率和危险因素进行分析。结果盐田区831例居民当中,慢性肾脏病的患病率为9．87％;慢性肾脏病人群当中,年龄、男性、饮酒、高血压、糖尿病、高尿酸血症的人数均明显高于非慢性肾脏病人群,且收缩压、血肌酐、总胆固醇均明显高于非慢性肾脏病人群（P＜0．05）;年龄、性别（男）、高尿酸血症、高血压和糖尿病是慢性肾脏病的危险因素（P＜0．05）。结论深圳盐田区慢性肾脏病的患病率略低;年龄、性别（男）、高尿酸血症、高血压和糖尿病是慢性肾脏病的危险因素。     

慢性肾脏病并发急性肾损害的病因和预后

目的:探讨慢性肾脏病并发急性肾损害的病因和预后。方法:回顾性分析我院2009年1月²014年1月收治的慢性肾脏病并发急性肾损害患者的临床资料,按年龄将其分为Ⅰ组和Ⅱ组,分析两组患者基础病因、诱发因素和转归。结果:Ⅰ组患者急性肾损害的基础病因以糖尿病肾病(23.2%)、高血压肾损害(18.8%)、慢性肾小球肾炎(17.4%)为主,Ⅱ组患者急性肾损害的基础病因以慢性肾炎(26.3%)、高血压肾损害(18.4%)、狼疮性肾炎(13.0%)为主,诱发因素以感染、高血压、药物性肾损害为主。结论:慢性肾脏病并发急性肾损害的基础病因危险因素在两组中是不同的,Ⅰ组中的老年人更应重视感染、各种药物肾损害等,及时发现病情变化,改善患者预后。     

Management of chronic kidney disease--preventing the progression of renal disease

Intraglomerular hypertension, and glomerular hypertrophy, leading to glomerular scarring are suggested to have an effect on the progression in chronic kidney disease, unrelated to the initial cause of kidney injury. Tubulointerstitial disease is another factor, which may affect the prognosis. Strategies to prevent or minimize the progression of kidney disease consist of treating these disease-worsening mechanisms, including smoking cessation, treatment of hyperlipidemia, sodium and protein restriction, antihypertensive therapy, inhibition of renin-angiotensin-aldosterone system, and treatment of anemia. Studies in experimental animals and humans suggest that these therapies are effective to prevent the progression in chronic kidney disease and there are some evidences that these therapies have benefits in the patients with chronic kidney disease.     

Antihypertensive therapy and mobilization of renal functional reserve.

The normal kidney can increase its rate of glomerular filtration in response to an acute protein load. It has been suggested that this acute hyperfiltration represents a renal functional reserve (RFR). The RFR has also been proposed to reflect the chronic hyperfiltration found in diabetic patients and animal models of chronic renal failure. The physiologic role of the RFR is still unclear. On the one hand, the availability of an RFR may retard the progression towards end-stage renal failure. On the other hand, sustained hyperfiltration has been implicated as a potential deleterious factor in the progression of renal disease. Antihypertensive drugs used in the management of hypertensive patients with chronic renal disease modify both the systemic and the renal hemodynamics. Depending on their hemodynamic effects, they may thereby alter the ability to mobilize RFR. Today, it is still not clear whether an ideal compound should increase, decrease, or not affect RFR to preserve long-term renal function. Evaluation of the effects of various antihypertensive agents on RFR could become an important aspect of consideration in order to optimize both the control of blood pressure and the capacity of the therapy to prevent deterioration of renal function.     

六味地黄丸治疗糖尿病合并高血压肾损害的临床观察

目的 探讨六味地黄丸对糖尿病合并高血压病所致慢性肾脏疾病(chronic kidney disease,CKD)患者肾损害及胰岛素抵抗的影响.方法 收集2008年7月1日-2010年7月1日在成都市第五人民医院住院部及门诊就诊的120例糖尿病合并高血压病患者相关资料,随机分为对照组和治疗组各60例,对照组给予西医治疗,...     

慢性肾病合并高血压临床分析(附348例报告)

[目的]探讨慢性肾病（CKD）合并高血压的临床特征和治疗情况.[方法]对本院肾病内科收治的CKD患者进行调查,统计伴有高血压的CKD患者的基本资料,对患者的临床特征和药物治疗进行总体分析.[结果]2008年1月至2011年1月间本院伴有高血压的CKD患者348例,占总肾病患者的48.9%（347/712）,CKD分期结果显示各期都有高血压患者,且慢性肾炎后期患者的高血压比例高于早期患者;对合并CKD的患者配合降压药物治疗后,患者血压得到有效控制,且患者24h尿蛋白、血肌酐值均明显降低（P＜0.01）,血白蛋白升高（P＜0.05）.[结论]高血压既是CKD的致病因素也是其治疗评价标准,有效控制CKD患者的血压有利于其肾病的治疗.     

Chronic kidney disease: evolving strategies for detection and management of impaired renal function

Nephrologists have long been concerned about late referral of patients with severe kidney disease, and resultant poor outcomes on dialysis. But there is an increasing realisation that mild to moderate chronic kidney disease is far more common than previously appreciated. Furthermore, the main consequence of chronic kidney disease is not progression to dialysis, but increased risk of cardiovascular disease. Chronic kidney disease is at least as common and important a risk factor for cardiovascular disease as diabetes mellitus. The MDRD formula is a well-validated formula to estimate glomerular filtration rate, which is now being widely implemented by clinical chemistry laboratories, and should increase the recognition of chronic kidney disease. The K/DOQI classification of chronic kidney disease has gained international acceptance and provides the structure to guide referral and management. This classification, and associated guidelines, also focus attention on areas where evidence is lacking, and which urgently require research. These current developments will substantially change and improve how chronic kidney disease is identified and managed.     

A structured literature review of pain assessment and management of patients with chronic kidney disease

Aims and objectives. This paper reviews the literature concerning nurses’ assessment and management of pain in adult patients with chronic kidney disease, and proposes implications for clinical practice to support the control of pain in these patients. Background. Chronic kidney disease is a worldwide public health concern with increasing incidence and prevalence, poor patient outcomes and high cost. Patients with kidney disease often experience pain. Optimal pain assessment and management are key clinical activities; however, inadequate pain control by health professionals persists. Renal failure compounds this problem because of the small margin between pain relief and toxicity, and the patient's concomitant health problems. Conclusions. The literature review uses 93 articles that were published in medical‐ and other health‐related journals, including 12 medical and pharmaceutical studies specifically relating to pain control in adults with kidney disease. Very little research has been conducted on pain in patients with kidney disease prior to requiring dialysis or kidney transplantation for survival. However, past research showed pain is common and analgesics are underprescribed in patients on dialysis in end‐stage kidney disease. The review indicates that an interest in nephrotoxicity and analgesic‐induced morbidity dominates over an interest in pain relief in patients with kidney disease. Most analgesics are excreted renally or by the liver, and the use of simple analgesics such as paracetamol is cautioned. Relevance to clinical practice. Findings from the literature review highlight specific difficulties relating to effective pain control in patients with chronic kidney disease. Research is required to identify and overcome barriers to effective pain management, including the development of specific tools to facilitate interventions that optimize analgesic outcomes in patients with chronic kidney disease.     

Treatment of HIV-associated nephropathies

In patients with HIV, the use of highly active antiretroviral therapy has improved life expectancy. At the same time, this increase in life expectancy has been associated with a higher frequency of chronic kidney disease due to factors other than HIV infection. Besides HIV-associated nephropathy, a number of different types of immune complex and non-immune complex-mediated processes have been identified on kidney biopsies, including vascular disease (nephrosclerosis), diabetes, and drug-related renal injury. In this setting, renal biopsy needs to be considered in order to obtain the correct diagnosis in individual patients with HIV and kidney impairment. Many issues regarding the optimal treatment of the different pathological processes affecting the kidneys of these patients have remained unresolved. Further research is needed in order to optimize treatment and renal outcomes in patients with HIV and kidney disease.     

实时剪切波弹性成像评价慢性肾脏病早期肾脏损害的价值

目的 探讨实时剪切波弹性成像（RT-SWE）技术在慢性肾脏疾病早期肾损害中的潜在应用价值。 方法 应用RT-SWE技术检测早期慢性肾病1~3期患者肾脏皮质杨氏模量均值（E_mean）,与患者24 h尿蛋白定量、血肌酐值及肾穿刺活检病理间质纤维化程度作对比;引入年龄因素校正E_mean值（pyE_mean）,比较早期慢性肾病各期患者pyE_mean值的差异。 结果 E_mean值在慢性肾病1~3期患者不同组的差异无统计学意义（P > 0.05）;根据患者年龄校正得出的pyE_mean值在慢性肾病1期与2期患者之间差异无统计学意义（P > 0.05）,但1、2期与3期的差异有统计学意义（P < 0.05）。 结论 pyE_mean值排除了年龄对肾脏硬度值的影响,对评估早期慢性肾病患者肾脏纤维化程度可能具有重要的潜在应用价值,RT-SWE技术可以应用于慢性肾病早期肾损害评估。      

Minor abnormalities of renal function: a situation requiring integrated management of cardiovascular risk

Changes in renal function related with essential hypertension are associated with an elevated cardiovascular morbidity and mortality. Indices of altered renal function (e.g. microalbuminuria, increased serum creatinine concentrations, decrease in estimated creatinine clearance or overt proteinuria) are independent predictors of cardiovascular morbidity and mortality. The Framingham Heart Study documented the relevance of proteinuria for cardiovascular prognosis in the community. The Intervention as a Goal in Hypertension Treatment (INSIGHT) Study assessed the role of proteinuria as a very powerful risk factor. It has also been shown that microalbuminuria along with primary hypertension poses a high risk for cardiovascular diseases. Recent data indicate that even minor derangements of renal function are associated with the clustering of cardiovascular risk factors observed in metabolic syndrome, that promote progression of atherosclerosis. All these parameters should be routinely evaluated in clinical practice, and considered in any stratification of cardiovascular risk in hypertensive patients. The high prevalence of chronic kidney disease in the general and in the hypertensive populations implies the need for an integrative therapeutic approach to fully protect renal and cardiovascular systems simultaneously.