The difference between hypertensive nephropathy and renal hypertension

Written by Zhou Qi
Nephrology
Updated on January 30, 2025
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Hypertensive nephropathy and hypertension due to kidney disease need to be differentiated, as this affects the treatment approach and prognosis assessment differently. Hypertensive nephropathy refers to patients with long-term high blood pressure, which causes arteriosclerosis of small vessels leading to renal pathology. Often, there is also arteriosclerosis in other organs, such as the retinal arteries, which can be confirmed through funduscopic examination. On the other hand, hypertension due to kidney disease occurs when a patient has kidney disease first followed by hypertension, where the causes and types of kidney diseases vary and can frequently lead to hypertension. The difference between the two lies in the sequence of occurrence. Hypertensive nephropathy is characterized by initial high blood pressure and commonly associated with arteriosclerosis in other vessels, which can be preliminarily identified through funduscopic examination. In cases of hypertension due to kidney disease, the patient has other kidney disorders first, followed by hypertension. If a patient's 24-hour urine protein quantification exceeds 2g, it is likely due to kidney disease rather than hypertensive nephropathy. If differentiation remains challenging, kidney biopsy can be performed for further differentiation.

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What is the general blood pressure for hypertensive nephropathy?

Hypertension caused by kidney disease is called renal hypertension. The blood pressure of patients with renal hypertension is generally higher than that of those with primary hypertension. However, these patients can exhibit any range of blood pressure types. Their blood pressure might be in stage 1, meaning the systolic pressure is between 140 to 160 mmHg. It could also reach stage 3, where the systolic pressure exceeds 180 mmHg. In cases of heart failure, the patient's blood pressure might even reach 220 or 240 mmHg, though such extreme cases are relatively rare.

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Which is more dangerous, low blood pressure or high blood pressure?

Blood pressure is a crucial indicator for maintaining human life. Both low blood pressure and high blood pressure can pose significant risks to the body. High blood pressure can lead to arteriosclerosis, and prolonged high blood pressure can cause cardiovascular and cerebrovascular diseases, with severe cases leading to cerebral ischemia and myocardial infarction. Low blood pressure affects the blood supply to vital organs and also brings negative factors to the body. Extremely low blood pressure can also endanger human life. Therefore, whether it is low blood pressure or high blood pressure, it should be correctly treated and improved under the guidance of a doctor to ensure the health of the body.

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What is the blood pressure for gestational hypertension?

Pregnancy-induced hypertension refers to a series of pathophysiological changes caused by elevated blood pressure in women during pregnancy. It is a severe complication of pregnancy that can have serious effects on both the mother and the fetus. The diagnostic standard for hypertension during pregnancy is the same as in non-pregnant periods, that is, a blood pressure greater than 140/90mmHg can be diagnosed as pregnancy-induced hypertension. However, pregnancy-induced hypertension can be classified based on whether it is combined with other conditions, as well as the severity of the condition. Depending on the severity, pregnancy-induced hypertension can be divided into categories such as gestational hypertension, pre-eclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed pre-eclampsia. These classifications are mainly based on the severity of the condition, and it is essential to treat pregnancy-induced hypertension with standardized care.

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The treatment goal for hypertensive encephalopathy is mainly to rapidly reduce blood pressure to a reasonable range. Typically, intravenous antihypertensive drugs are administered to decrease blood pressure by 20%-25% within the first hour, followed by oral antihypertensives or continued intravenous treatment to further reduce it to a more reasonable level. Hypertensive encephalopathy often accompanies cerebral edema, and patients may experience increased intracranial pressure. At this point, it is necessary to administer dehydrating agents such as mannitol to treat the cerebral edema. If the patient experiences seizures, which can cause an increase in blood pressure or difficulty in reducing blood pressure, sedative anticonvulsant drugs must be administered to control the seizures. If the patient shows signs of heart failure, diuretic treatment should be initiated. Additionally, high concentration oxygen therapy under high pressure should be administered, which can be delivered through nasal cannula. If nasal oxygen therapy is ineffective, non-invasive ventilation or even intubation with invasive ventilation may be used to provide high concentration positive pressure oxygen therapy.

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As living standards improve, a blood pressure monitor has become an essential medical device in households. Electronic blood pressure monitors are very convenient for measuring blood pressure, especially for patients with hypertension. They allow patients to measure their blood pressure timely and adjust medication dosages accordingly. How to read a blood pressure monitor varies with different models. Typically, on an electronic blood pressure monitor, the first line displays the systolic pressure, also known as high blood pressure; the second line displays the diastolic pressure, also known as low blood pressure; and the third line displays the heart rate. These readings can help you know your systolic and diastolic pressures.