慢性肾脏病并发高血压危象临床分析

Clinical features and prognosis of chronic kidney disease with hypertensive crisis

目的探讨慢性肾脏病（CKD）合并高血压危象患者的发病诱因、诊治时间与肾功能改善的相关性。方法回顾性分析我院10年来发生高血压危象的38例CKD患者的临床资料，对表现为慢性肾衰竭急性加重的患者进行随访。结果38例中，15例发生高血压危象时有明确诱因，主要为情绪激动、过度劳累和大量饮酒。高血压危象发病季节以秋冬季为主，就诊时间在起病24h之后居多。在18例表现为慢性肾衰竭急性加重的CKD患者中，24h内就诊者出院时肾功能明显改善，平均随访1年，坚持降压治疗者进入替代治疗的比率显著低于未规律服药者（P=0．020）。结论高血压危象使CKD患者的肾功能急剧恶化，及时就诊和有效的降压治疗可以延缓肾功能恶化。

Objective To study the clinical characteristics and prognosis of chronic kidney disease with hypertensive crisis. Method This retrospective study comprised the analysis of the medical records of 38 chronic kidney disease patients with an elevation of diastolic blood pressure more than 120 mmHg in our department from 1996 to 2006,renal function was followed up for 1 year. Results In 38 patients with hypertensive crisis, 15 patients with obvious, inducing factirs; emotional upset, overfotigae and heavy drinking. The onset of hypertensive crisis was more frequant in autumn and winter,and most of the patients were treated more than 24 hours after onset of crisis. Of 38 cases, 18 wase chronic renal failure presenting acute exacerbation, after antihypertensve therapy, the renal function could be reversed invarions degiel, and it was distinguishing in patients who neceived treatnuent within 24 hours afteronset of obcrisro. 18 patients CRF with acute renal failure were followed up for about one year. Patients who hed receiocd appropriate treatment started renal replacement theraphy later than that who hed receiocd freatment irregulareg did not （P = 0. 020）. Conclusions The acute renal failure occurg in patients with chronic kidney disease with hypertensive crisis can be reversed by effective and timely antihypertensive therapy.