Hypertension renal arteriolar sclerosis

　　Summary: department of primary hypertension caused by benign arteriolar nephrosclerosis (also known as hypertension renal arteriolar sclerosis) and malignant arteriolar nephrosclerosis, accompanied by corresponding clinical manifestations of the disease. Age more than in 40 ~ 50 years of age or older, hypertension 5 ~ 10 years of history, early only nocturia increased, then appear proteinuria, individual cases can occur due to the broken capillaries of transient with macroscopic haematuria, but without obvious lumbago, often merge arteriosclerosis sex retinopathy, left ventricular hypertrophy, coronary heart disease, heart failure, cerebral arteriosclerosis and (or) history of cerebrovascular accident.
　　Causes:
　　1.the weight and obese factors: weight gain is not only lead to obesity, is also a risk factor for hypertension, the more body fat, the greater the risk of hypertension.
　　2.high salt diet
　　3.drink
　　4.mental psychological factors: work tension, mental burden is heavy, irregular life, long-term stay up late, lack of sleep or rest, all can lead to high blood pressure
　　5.the body calcium is also one of the leading causes of high blood pressure disease happens.
　　6.genetic factors: study at home and abroad, high blood pressure have a strong genetic predisposition, but genetic factors and environmental factors interact with each other only can lead to a rise in blood pressure.
　　7.weather factors: because of the weather gets cold, the skin and subcutaneous tissue blood vessels to contract, causing peripheral vascular resistance increases, leading to increased blood pressure.
　　Features: slow progression of symptoms a few gradually develop into renal failure, most perennial mild renal function damage and abnormal urine routine, malignant high blood pressure, diastolic blood pressure should be more than 16 kpa (120 MMHG), accompanied by obvious cerebrovascular complications and rapid development, a large amount of proteinuria, often accompanied by hematuria, progressive renal function decline.
　　Early prevention:
　　first, the age of 40 and 50 years of age or older, hypertension 5-10 years of history, if determined to trace albumin increase, should be on high alert.
　　Second, nocturia increased, appear proteinuria or transient hematuria, will always check the renal function, urinary protein qualitative, quantitative, 24 hours urinary protein attention to measure blood pressure, do fundus examination.
　　Third, maintain defecate unobstructed.
　　Iv. Avoid contact with heavy metals, toxic substances and possible damage to the kidney drug.
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The choice of protein for patients

　　The choice of protein for patients
　　1, plant protein, because it contains a lot of purine base, can aggravate kidney intermediary metabolism burden, it should be less.
　　2, should give rise to different types of proteinuria and kidney disease according to a different standard protein diet. Chronic nephritis, generally according to the normal supply requirements, adult daily 0.8 ~ 1.0g / kg. Physiological should choose high-value protein, such as eggs, dairy, fish, lean meat and so on.
　　3, for without renal impairment nephrotic syndrome, could supply high-protein diet, protein adult daily 1.5 ~ 2.0g / kg, and the supply of high quality protein, blood urea nitrogen levels were, generally taking a low protein diet is appropriate.

　　4, nephrotic syndrome, in addition to the loss of a lot of protein in the urine, but also with the loss of proteins bind calcium, magnesium, zinc and other minerals, should eat more fresh vegetables and fruits, supplement calcium-rich foods, fish and green vegetables.
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High uric acid

High uric acid
Overview: high uric acid is a kind of metabolic disease, which caused by purines metabolic disorder and uric acid rising in the blood.
Symptoms:
1, asymptomatic high uric acid hematic disease: blood tests can be found that the blood uric acid concentration increased, but not in arthritis, high uric acid stones, or kidney stones and other clinical symptoms. Asymptomatic high uric acid hematic disease sustainable 10 to 20 years, some can not appear high uric acid. For life. Generally the higher the blood uric acid level, the greater the risk of high uric acid.
2, acute high uric acid sex arthritis: four seasons all can come on, in the spring and autumn the most. Joint local damage, feast on crapulence, excessive fatigue, damp, certain drugs, infection and surgical operation can induce acute episodes.
Control:
1, proper aerobic exercise, must not to do strenuous exercise, so as to avoid joint strain. Had better choose swimming aerobics, tai chi, table tennis to lose weight.
2, drink plain boiled water or light tea, daily urine output to control in about 2000 ml is the best. More than westerners to reduce uric acid and drink apple cider vinegar. Don't drink strong tea, coffee sweet drinks.
3, eat more vegetarian, but not all vegetarian diet to eat more, eat more green, purple eggplant, Shanghai lettuce. Green vegetables diet spinach, then all the beans to eat less or not. Eat more fruits, all kinds of fruits are composed of carbohydrates, let the body more alkaline have a positive effect, especially eat cherry.
4, eat less meat. Don't eat seafood and animal innards and hot pot (fish can eat less, drink more water after eating).
5, beer is prohibited. Other wine drinking or not strictly limited.
6, often with hot bubble foot habit, every time not less than 20 minutes, no more than 30 minutes, to the whole body sweating slightly better. When wash feet, can add appropriately promoting blood circulation to remove blood stasis of Chinese medicine.
7, all the blood uric acid or claims for the treatment of gout drug, have side effects on kidney, liver is very big, drug uric acid is the most pyrrhic victory.
8, distribute work, pay attention to sleep, relaxed state of mind, optimistic face. Once every half a year check uric acid, strive to control at around 350, gout will not cause damage to any joint.
Treatment:
1. row of uric acid prescription: row of uric acid medicine mainly includes probenecid, sulfonated pyrazole ketone, benzene bromide Malone, etc. The drug can prevent renal tubular reabsorption of uric acid, increase the excretion of uric acid, which have the effect of lowering blood uric acid level in the human body. Side effects is the line of uric acid and other trace elements out of the body, the body can cause low blood sodium, potassium, calcium, but also have side effect to liver, kidney, so can't long use.
2. The inhibition of uric acid generated drugs: current clinical commonly used drugs inhibit acid production is don't Piao alcohol. The drug is a kind of powerful purine oxidase inhibitors, it is so far only can effectively reduce uric acid generation and reduce the level of uric acid in the human body. Although the allopurinol with less adverse reaction, but the person that liver and kidney dysfunction should be careful.
3. Alkalize urine drug: there is no drop uric acid sodium bicarbonate alkaline drugs such as role, but can be alkalize urine, increase the solubility of uric acid in the blood, make the uric acid is not easy to accumulate and form crystallization in the urine.
Diet for high uric acid:
1. Shall provide plenty of carbohydrates and fats. Such as cardiovascular and kidney had no adverse effect, should drink more.
2. The cooking methods multi-purpose stewed, boiled, boil, steam and diving, decoct, fry way less. Food should be easy to digest.
3. Choose foods rich in vitamin B1 and vitamin C more. Available food: rice, noodles, milk, fruit and all kinds of vegetable oil.
4. Vegetables in addition to the asparagus, broccoli, spinach, other are edible.
5. To disable the animal internal organs, roe, bone marrow, sardines, mussels, oysters, shrimp skin, mackerel, meat, liver, kidney, brain, clams, crab, fish, soup, chicken soup, peas, lentils, mushrooms, etc., all kinds of strong condiment and strengthen the nervous excitement of food such as wine, tea, coffee, spicy taste, etc.
6. Maintain ideal weight, overweight or obese should reduce weight. However, weight loss should be step by step, otherwise easy to cause acute ketosis or gout.
7. Carbohydrates can promote uric acid eduction, patient edible rice is rich in carbohydrates, steamed bread, pasta, etc.
8. Protein can according to the weight, according to the proportion to ingest, 1 kilogram of body weight should be 0.8 g to 1 g of protein intake, and given priority to with milk, eggs. If it is lean meat, chicken, duck, etc. should boil to eat soup, avoid eating stew or braised pork.
9. Eat less fat, fat can reduce uric acid eduction. Gout complicated with hyperlipidemia, fat intake should be controlled within the total quantity of heat of 20 to 25.
10. Drink lots of water, daily should drink 2000 ml to 3000 ml, promote the uric acid. Eat less salt, every day should be restricted to 2 grams to 5 grams.
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High creatinine

　　High creatinine
　　High creatinine refers to creatinine value is higher than normal, creatinine including serum creatinine and urine creatinine, but serum creatinine is more meaningful to measure renal function. So high creatinine is generally refers to serum creatinine is on the high side. Serum creatinine in each hospital is not the same as the measure of normal, serum creatinine in general normal standard is: 44-133 mu mol/L, when more than 133 mu serum creatinine mol/L means that the kidney damage, have renal insufficiency, renal failure. More than 133 mol/L for inflammatory lesions, 186 mu of mol/L for renal damage, 451 mu of mol/Lfor renal failure.
　　Symptoms of high creatinine
　　Symptoms of high creatinine value, mainly include the following: 1. The edema often begin with eyelid edema (a part of patients from the first leg), seriously affected the body appear even pleural effusion and ascites. 2. High blood pressure is one of the high creatinine value performance. 3. The frequency (more), urgency, (can not to suppress the urine), urine pain (the lower abdomen pain and urethra to pass urine). 4. The waist pain mostly dull pain, surgical disorders can appear severe cramping. 5. Blood in the urine blood is contained in the urine, or assay in positive occult blood (a plus). 6.more Urine: every day more than 2500 ml. 7. Oliguria or anuria every day less than 400 ml of oliguria, less than 100 ml anuria. 8. Urine bubble may be a manifestation of urine protein increased more, assay of urine protein positive is reliable evidence of urine protein increased.
　　Significance of high creatinine
　　When serum creatinine is significantly higher than normal, often has serious damage to kidney function. After the serum creatinine increased, the most important thing is to take measures to treat, although may be increased serum creatinine is not much, but has become a serious kidney damage, because the kidneys have strong compensatory function, the mild and moderate damage, increased serum creatinine may not be obvious, normal renal injury by more than 80%, increased serum creatinine is obvious. Therefore, once found an increased serum creatinine should cure of as soon as possible.
　　Examine of high creatinine
　　When patients with elevated creatinine should first pay attention to not disorderly use the drug induced renal damage, such as: pain killers. Secondly, come to the hospital regularly, then observe the changes of creatinine and urea nitrogen. Again, don't tired, don't stay up late, proper exercise, ready to prevent an infection. Finally is scientific and reasonable diet, give priority to with light diet, don't eat rich food, contains high purine food also cannot eat, can eat foods contain high quality protein but the amount not much, edema and hypertension eat salt restriction.
　　When creatinine increased patients will have symptoms, it's just ignored by people. When people's increased creatinine value will appear after night urine, fatigue, thirst, body appears edema, blood pressure, heart failure, the symptom such as pulmonary edema, which is the performance of water metabolism imbalance. Occurs when there is a metabolic acidosis patients don't want to eat, weakness, restlessness, abdominal pain, vomiting, and even coma. These are obvious symptoms, in addition to patients with elevated creatinine by checking also found to have high and low sodium, high and low potassium hematic disease, slow growth, such as sexual dysfunction, which is also an expression of the high creatinine. When people of the above symptoms should make a detailed physical examination to the hospital, don't ignore believed to be caused by fatigue.
　　Harm of high creatinine
　　harm is mainly manifested in the following several aspects:
　　first, the sodium metabolism imbalance: high creatinine will appearhyponatremia or high sodium.
　　Two, potassium metabolism disorders: high creatinine often accompanies a hyperkalemia or hypokalemia.
　　Three, water metabolism disorders: including polyuria, nocturia increased, thirst, dry mucosa, fatigue, etc.; Or systemic edema, high blood pressure, pulmonary edema and heart failure, etc.
　　Four, aluminum, magnesium, copper, zinc, selenium metabolic abnormalities, etc.
　　Five, renal bone disease: bone pain and proximal muscle weakness; Bone pain is often generalized, pragmatic under bust bone and skeletal deformities can cause symptoms such as short stature.
　　Six, metabolic acidosis: patients with high creatinine can have large and long deep breathing, lack of appetite, abdominal pain and nausea, vomiting, weakness, headache, restlessness, and even coma.
　　Seven, blood system disease, such as renal anemia, etc. High on behalf of glomerular filtration rate and serum creatinine kidney detoxification function decline, at this point, the kidney disease in patients with renal function damage, entered the stage of renal insufficiency. And with the increase of serum creatinine index continued, the patient's kidney function damage degree will be more and more serious, normal creatinine between 40 ~ 120. If creatinine above this range, then process into the kidney in patients with pathological changes, creatinine tall if not treated, can cause great harm, but also develop into uremia.
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pulmonary infection

　　pulmonary infection
　　classify：
　　1. The bacterial pneumonia: such as streptococcus pneumoniae, staphylococcus aureus, group a hemolytic streptococcus, with white clay pneumoniae, haemophilus influenzae, pseudomonas aeruginosa, Mr Bush escherichia coli, pseudomonas aeruginosa and so on.
　　2. Pneumonia caused by atypical pathogens, such as legionella bacteria, mycoplasma and chlamydia, etc.
　　3. The viral pneumonia: such as coronary virus, adenovirus, influenza virus, cytomegalovirus, herpes simplex virus, etc.
　　4. The fungal pneumonia: such as white candida, aspergillus, radiation bacteria, etc.
　　5. Other pathogens caused by pneumonia: such as rickettsia, toxoplasma, protozoa and parasites such as pulmonary hydatid, lung trematode, etc. People with poor immunity, such as HIV/AIDS patients easily with cartesian pulmonary lung steamed stuffed bun, legionella, bird-like mycobacterium, n/med tuberculosis bacterium, toxoplasma infection, etc.
　　6. The physical and chemical factors caused by pneumonia: such as radioactive pneumonia, gastric acid inhalation, chemical pneumonia caused by drugs, etc.
　　7. mycoplasma pneumonia caused by mycoplasma infection.
　　Symptoms:
　　Difficulty in breathing, temperature changes, cough, sputum volume increased with sputum traits.
　　Causes:
　　Inhalation injury, tracheotomy or tracheal intubation, aspiration, pulmonary edema, atelectasis, shock, anesthesia, wound invasive infection, purulent thrombophlebitis etc.
　　Diagnoses:
　　1. Pay attention to the presence of inhalation injury, tracheotomy or tracheal intubation, aspiration, pulmonary edema, atelectasis, shock, anesthesia, wound invasive infection, purulent thrombophlebitis etc.
　　2. Pay attention to have difficulty breathing, temperature changes, cough, sputum volume increased with sputum traits. Should be paid attention to clinical symptoms and effects of burns or sepsis.
　　3. The physical examination. Severe burn patients, chest has burn more, more difficult to obtain accurate chest signs. Therefore, we should pay attention to check, have without breathing change and then sound and so on.
　　4. To identify bacteria infection, airway secretions within training should be done regularly, best for bronchial lung lavage cultivation, in order to prevent the pollution.
　　5. Chest X-ray. After burn most lung infection diagnosis depends on X-ray. Line should be regular chest radiography after injury, after review on a regular basis. X-ray manifestation of pneumonia can be divided into small lesions, large lesions and three, lobar pneumonia is the most common small lesions.
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Typical cases of urinary protein elimination

　　Xiaobo comes from Inner Mongolia, 1st, May, 2016 suddenly appeared edema, swollen eyes hard to open. Xiao is his mother dearly loved baby, his mother took him to the nearest hospital in a hurry at that night.
　　After a test, his protein is 3+, local doctor diagnosed -- nephrotic syndrome. Protein 3+ on such a small child, the local doctor recommended hurriedly hormones to control the disease. Steroid and calcium, Xiaobo is treated 27 days, review the results of all negative urine, edema disappeared. Disease is finally good, the family happily discharged. Things are not so simple,after three days Xiaobo relapse. And systemic edema, proteinuria became 3+ again. This time his mother are better hurry, This time more anxious mother, and how the disease is always back and forth, watching the children look pitiful, heart sour. The hospital had never been seen also know a lot of patients, patients recommended his mother to take her to Shijiazhuang Kidney Disease Hospital. The first thing that came to Shijiazhuang is test, this is not the results came out, the urine protein 3+. 24-hour urinary protein excretion is 3.05g. Such test results are expected child mothers. She even thinks the child will do long-term relapse plan, but the doctor's words made her renewed confidence. "In fact, the treatment of kidney disease must first clear the blood of toxins, our traditional therapies cure kidney disease, they often do not know the key to treatment is to clean up the blood accumulated a lot of toxins, and then use the symptomatic treatment of renal drugs. Blood is unclear but direct symptomatic medication, this will certainly lead to bad treatment, and easily repeated. the reason is simple, when people accumulate a lot of blood of toxins, the effect of any drug use are not good enough. " Dr. Fan carefully explain to the child’s mother about the misunderstanding cure kidney disease. After the clear serum drug treatment for 10 days, Xiaobo edema disappeared, and the spirit is getting better. Children's performance is not going to lie, to see him playing together with doctors and nurses, we can know his disease is better and better. After 10 days we again review, we look at the current urine of Xiaobo. Congratulations Xiaobo’s urine protein has a negative. 24-hour urinary protein excretion also dropped 0.13g.
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Proteinuria

　　Proteinuria
　　as a result of glomerular filtration membrane filtration function and renal tubular reabsorption function, healthy urine protein (much smaller molecular weight protein) content rarely (less than 150 mg daily discharge), protein qualitative check, the negative reaction. When urine protein content increased, the ordinary routine urine examination can detect, called proteinuria. If the acuity 3.5 g / 24 h urine protein content, it is called a massive proteinuria.
　　Proteinuria is the typical symptoms of chronic kidney disease, the reasons for the formation of Proteinuria and glomerular barrier function of the intimate relationship. The glomerular capillary consists of three layers structure from the inside out of endothelial cells, basal membrane layer respectively and the epithelial cell layer. Because the three layers of cells are filtering holes of various sizes and negative charge, so the barrier function of glomerular capillary can points two kinds, namely mechanical barrier, filter hole and charge barrier, negative charge.
　　Examination
　　Urine protein test is divided into qualitative and quantitative inspection and special inspection:
　　1. Qualitative check
　　Best for the first time in the early morning urine routine urine, morning urine is the most strong, and can eliminate orthostatic proteinuria. Return urine specimens, the abandoned in the former period, return midway through the urine. Qualitative check just preliminary examination, the kidney disease diagnosis, therapeutic observation and judgement shall do further quantitative inspection.
　　2. quantitative check
　　24 hours urinary protein quantitative, accurate to return 24 hours urinary protein, blending, in urine samples.
　　3. special examination
　　Such as urine protein electrophoresis, light chain quantitative urine, urinary tract ultrasound, renal biopsy and pathological examination, based on clinical diagnosis and the need for inspection.
　　Diet nursing principles of proteinuria
　　Albuminuria is an important clinical kidney disease patients.
　　1. Patients with proteinuria is generally need to have a rest, reduce the burden of kidneys and improve kidney function and reduce the symptom of proteinuria.
　　2. Observe the patient's blood pressure. Have proteinuria in patients with hypoalbuminemia and results in the decrease of blood volume and hyponatremia, prone to orthostatic hypotension and even syncope. Therefore, to instruct client don't activities, and monitoring the blood pressure regularly.
　　3. The diet nursing care. Patients with dietary protein supply according to kidney condition. In general, lost due to protein excretion from urine protein, serum albumin. Therefore, in the situation can be under the premise of renal function should be appropriately increased protein intake, and ensure the adequate supply of heat. If the patient's kidney function is poor and even take a low protein diet in uremia. And supply should be high quality protein, protein such as milk, lean lean, etc.
　　4. The examination of the urine protein on a regular basis. Generally do routine urine twice a week, a quantitative check urine specific gravity and 24 hours urinary protein.
　　5. Patients with proteinuria symptoms should be in suitable temperature and humidity, sunshine, ventilation is good, the living environment of fresh air. And the room regularly disinfected. Lost due to long-term patients with proteinuria protein, decreased with edema and make the skin resistance, easy infection, therefore, attention should be paid to the patient's personal skin clean and bed sheets, clothing hygiene clean, can use warm water scrub, massage the skin. Encourage patients often turn, etc.
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