Approach To The Patient With Hypertensive Nephrosclerosis
CHRONIC RENAL DISEASE(2015)
摘要
Hypertensive nephrosclerosis (HN) is defined as chronic kidney disease caused by nonmalignant hypertension (HTN). HN is the presumed underlying disease in 10-30% of patients with end-stage renal disease worldwide. HN typically presents without proteinuria or any abnormalities in the urine sediment. The mechanisms of injury in HN are heterogeneous. In areas with preserved arteriolar myogenic responses (i.e. autoregulation), there is ischemic glomerular tuft collapse and interstitial fibrosis. In other areas with impaired autoregulation, the lesions reflect glomerular HTN leading to podocyte loss and glomerulosclerosis. Apolipoprotein-L1 gene mutations are associated with increased susceptibility to HN. The management of HN should focus on blood pressure control (target < 140/90 mm Hg) using a blocker of the renineangiotensin system as base therapy.
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关键词
blood pressure
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