Dermatology

A Synopsis of Renal Diseases by A. M. Davison (Auth.) PDF

By A. M. Davison (Auth.)

ISBN-10: 0723605696

ISBN-13: 9780723605690

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T h e r e is also an increased incidence of vascular disease, particularly a t h e r o m a . T h e cause o f d e a t h in essential h y p e r t e n s i o n is: Left ventricular failure 30-50% Cerebrovascular disease 10-20% Renal faüure 10% Unrelated t o h y p e r t e n s i o n 30% T h e high incidence of cardiovascular disease indicates t h e i m p o r t a n c e o f identifying a n d controlling b l o o d pressure in hypertensive p a t i e n t s . MALIGNANT HYPERTENSION (Accelerated Hypertension) T h e t e r m 'malignant h y p e r t e n s i o n ' is used t o describe a chnical s y n d r o m e consisting of: Retinopathy - h a e m o r r h a g e s , e x u d a t e s a n d papilloedema.

In a satisfactory test t h e plasma b i c a r b o n a t e should fall b y 2 - 3 m m o l / l indicating a d e q u a t e h y d r o g e n i o n p r o d u c t i o n . 4 . I n n o r m a l subjects t h e urine pH should fall b e l o w p H 5-4. Failure o f t h e urine p H t o fall b e l o w this value indicates renal t u b u l a r acidosis. I n clinical practice it is frequently sufficient t o test a m o r n i n g urine sample. If t h e pH is 5-5 or less t h e n t h e r e is n o advantage in p r o c e e d i n g t o a formal acidification test as o u t l i n e d above.

This investigation has n o place in t h e r o u t i n e investigation of patients. Management 1. Medical Many p a t i e n t s will have satisfactory c o n t r o l with t h e use of diet, diuretics a n d h y p o t e n s i v e drugs. /3-blockers are of particular value. 2. Surgery, This should only be e m p l o y e d in p a t i e n t s w h o c a n n o t b e controlled b y medical means. In a t h e r o m a it is possible t o p e r f o r m vein bypass, t h r o m b o e n d a r t e r e c t o m y , p a t c h angioplasty or t o insert a D a c r o n prosthesis.

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A Synopsis of Renal Diseases by A. M. Davison (Auth.)


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