Post Date December, 03 2023
The kidney has a strong reserve capacity, often with little or no symptoms in the early stages of the disease, and diagnosis largely relies on laboratory tests. Renal injury in hypertensive patients is not an insurmountable or incurable condition. As long as urine and other indicators are regularly checked, it can be detected and controlled early.
Urinary routine
Urinary routine monitoring is a simple and cost-effective examination method that can determine whether a patient has hematuria, proteinuria, tubular urine, and so on. Proteinuria is an important observational indicator for monitoring the degree of early renal damage in hypertensive patients. 4% -16% of hypertensive patients who did not receive antihypertensive treatment showed proteinuria (>200 mg/day). Hypertensive patients should regularly check their urine routine, at least once a year or six months. For those with prolonged hypertension, the monitoring interval should also be shortened. The disadvantage of routine urine examination is that its sensitivity is limited, and sometimes it is easy to miss some hypertensive patients with mild renal damage.
Urinary albumin quantification
40 year old Xiao Chen went to the hospital for treatment due to increased nocturia. Professor Wang, who received the diagnosis, carefully inquired about his medical history and found that Xiao Chen had hypertension for 6 years. He then underwent a routine urine test and suggested that he undergo a quantitative urine albumin test. Xiao Chen is very puzzled. What kind of test is this urine albumin quantification and what is its significance? Professor Wang told him that quantitative testing of urinary albumin, also known as quantitative testing of microalbumin in urine, is one of the commonly used methods for screening early renal damage in hypertension, and its sensitivity is superior to routine urine testing. Many hypertensive kidney injuries may not have obvious symptoms in the early stages, but through urine albumin quantification, kidney damage can be detected in the first place. Under normal circumstances, there is very little albumin in urine, and the specific amount is no more than 10 mg per day. The quantitative amount of albumin is 10-29 mg per day, which is already albuminuria. As the disease progresses, the urinary albumin levels of hypertensive patients may gradually increase. Due to the cumbersome operation of collecting 24-hour urine, we can also use a random urine albumin/creatinine ratio to evaluate the amount of urine albumin.
The occurrence of albuminuria in hypertensive patients is an alarm bell for kidney damage. Although the patient's renal function indicators may still be completely normal at this time, if active and correct treatment measures are not taken in a timely manner, renal function will gradually decline and enter chronic renal failure. Therefore, hypertensive patients must pay attention to regular testing of urinary albumin. Generally speaking, patients with ordinary hypertension should be tested at least once a year, while patients with elevated urinary albumin should be tested every three months.
Urine β 2 microglobulin
Under normal circumstances, β After free filtration from the glomerulus, 2-microglobulin is reabsorbed by the renal tubules, resulting in a low content in urine. In the early stage of renal tubular dysfunction, the excretion of B2 microglobulin in urine will significantly increase. So, β 2-microglobulin has been recognized as one of the sensitive indicators reflecting early renal damage in hypertensive patients, but interference factors such as infection, fever, and recent vaccination must be ruled out.
Urinary NAG
NAG (N-Acetyl One β— D-glucosaminidase is a lysosome derived from the proximal convoluted tubules, which is relatively stable in urine and cannot be filtered through the glomerulus. When renal tubular cells are damaged, urinary NAG levels significantly increase, much earlier than changes in urinary protein and renal function abnormalities, and can be used as an early sensitive indicator to reflect renal tubular damage in hypertension.
