High Blood Pressure and Proteinuria in Hypertensive Nephropathy

Patients of hypertensive nephropathy usually have years’ illness history of high blood pressure and impairment of renal tubules is earlier than that of the glomerulus. Usually patients will have increased night urination, declined renal function of urine concentration, slight urinary changes and proteinuria and there can also be microscopic hematuria and cylindruria.

Often, patients will have complications in target organs. Cerebrovascular complications are the major ones which might appear earlier and are more severe than renal damages and they are the key factor affecting the prognosis.

Hypertensive nephropathy is renal damage caused by long term primary high blood pressure. The kidney itself is an organ of blood capillaries. It has the functions of filtering wastes and toxins out of the body and at the same time preventing leakage of protein and blood cells. High blood pressure will cause blood pressure to increase and cause protein to be leaked out. Protein leakage will in turn damage the glomerular filtration membrance and the illness conditions will fall into a vicious circle. If this condition can not be treated timely and properly, the damages will become irreversible and the kidneys will be enlarged or even failed. That is why proteinuria is a more serious condition than hematuria in hypertensive nephropathy.

Since the renal tubules are first damaged, therefore in the early stage proteinuria is not very severe. Usually it is mild to moderate (+ or ++) and 24-hour protein quantitative is usually less than 2g, but some patients will have large amount of protein in urine. In case of capillary rupture, there will be temporary blood in urine.

Since proteinuria is serious condition, timely and effective treatments should be received. Whatever the treatment is, it should aim at protecting and preserving kidney functions.

The first step for treating proteinuria in hypertensive nephropathy is to bring high blood pressure down and maintain it in a normal range. Effective treatments should have the following functions of dilating blood vessels, anti-inflammation, anti-coagulation and degradation of extracellular matrix. Only when the blood pressure is lowered and damaged renal tissues are repaired can proteinuria disappear naturally.