It is a disease caused by primary hypertension leading to benign arteriolar nephrosclerosis (also known as hypertensive arteriolar nephrosclerosis) and malignant arteriolar nephrosclerosis, accompanied by corresponding clinical manifestations.

bubble_chart Auxiliary Examination

1. Mostly mild grade II proteinuria, with 24-hour quantification mostly between 1.5-2.0g; microscopic examination shows few formed elements (red blood cells, white blood cells, hyaline casts), and may present with hematuria; early-stage hematuria acid levels are elevated, with increased urinary NAG enzyme and β2-MG, and impaired urine concentration-dilution function; Ccr often declines slowly, while hematuria nitrogen and creatinine levels rise. Tubular function damage often precedes glomerular function impairment.
2. Imaging studies usually show no changes in the kidneys, but varying degrees of kidney shrinkage may occur when progressing to renal failure; radionuclide tests reveal renal function damage early on; electrocardiograms often indicate left ventricular high voltage; chest X-rays or echocardiograms frequently suggest aortic pulse sclerosis, left ventricular hypertrophy, or enlargement.
3. For cases with difficult clinical diagnosis, a renal biopsy should be performed in the early stages.

bubble_chart Diagnosis

1. Medical History and Symptoms

Most patients are aged 40–50 or older, with a history of hypertension lasting 5–10 years or more. In the early stages, the only symptom may be increased nocturia, followed by the appearance of proteinuria. In rare cases, transient gross hematuria may occur due to capillary rupture, but without significant lumbago. It is often accompanied by arteriosclerotic retinopathy, left ventricular hypertrophy, coronary heart disease, heart failure, cerebral arteriosclerosis, and/or a history of cerebrovascular accidents. The disease progresses slowly, with a small proportion gradually developing into renal failure, while most patients exhibit long-term grade I renal impairment and abnormal routine urinalysis. In malignant hypertension, diastolic blood pressure must exceed 16 kPa (120 mmHg), accompanied by significant cardiovascular and cerebrovascular complications that progress rapidly, along with massive proteinuria, often accompanied by hematuria and progressive deterioration of renal function.

Generally, blood pressure remains persistently elevated (20.0/13 kPa, 150/100 mmHg or higher); some patients exhibit eyelid and/or lower limb edema, cardiac enlargement, etc. Most show arteriosclerotic retinopathy. The presence of striate or flame-shaped hemorrhages and cotton-wool exudates in the fundus supports the diagnosis of malignant renal arteriolosclerosis. Patients with hypertensive encephalopathy may exhibit corresponding neurological focal signs.

bubble_chart Treatment Measures

1. For early-stage, grade I hypertension with roughly normal urine routine tests, non-pharmacological treatment can be administered, including maintaining a good mood, weight loss, salt restriction, alcohol restriction, practicing qigong and tai chi, and appropriate physical exercise.
2. Available antihypertensive medications include:
   1. diuretics;
   2. β-blockers;
   3. calcium antagonists;
   4. angiotensin-converting enzyme inhibitors (ACEIs). Among these, calcium antagonists and ACEIs are more beneficial for renal hemodynamics, and ACEIs are superior to other antihypertensive drugs in reducing urinary protein. Effectively controlling blood pressure to normal or near-normal levels (18.7/12 kPa, 140/90 mmHg) can prevent, stabilize, or delay hypertensive kidney damage.
3. For patients with malignant renal arteriolar sclerosis whose renal function deteriorates rapidly within a short period, intravenous medication may be administered when accompanied by hypertensive encephalopathy, rapidly declining vision, intracranial hemorrhage, or inability to take oral medications. Sodium nitroprusside is commonly used, aiming to control blood pressure within 12–24 hours. Minoxidil can rapidly lower blood pressure and is suitable for the initial treatment of malignant hypertension.
4. For those with concurrent hyperlipidemia, diabetes, or hyperuricemia, corresponding treatments should be provided. Additionally, the use of antiplatelet aggregation and adhesion drugs, such as dipyridamole and aspirin, may help prevent renal arteriolar sclerosis.
5. In cases of renal insufficiency, non-dialysis and replacement therapies should also be administered, as detailed in "Chronic Renal Insufficiency."
6. Maintaining smooth bowel movements is recommended, using Qingning Wan or Mojia Qingning Wan. Chinese medicinals such as Bupleurum, Bitter Orange and Platycodon Decoction or Gastrodia and Uncaria Drink may be used.

AD

TCM can effectively treat dry eye syndrome, floaters, retinopathy, and various chronic eye diseases

bubble_chart Differentiation

Secondary hypertension, especially the hypertensive type of chronic nephritis, should be excluded. Malignant renal arteriolosclerosis should be differentiated from rapidly progressive nephritis, systemic vasculitis, and other conditions.