Assessing Your Hypertensive Patient For Renal Disease

Because your hypertensive patient has an increased risk of developing renal disease, monitor his laboratory results for the following.

Stage I: Diminished Renal Reserve

* reduced kidney function with no accumulation of metabolic wastes

* mild elevation in blood urea nitrogen (BUN) and creatinine levels

Stage II: Renal Insufficiency

* mild accumulation of metabolic wastes

* elevated BUN, creatinine, uric acid, and phosphorus levels

* anemia

* mild hyperkalemia

* reduced ability to concentrate urine

Stage III: End-stage Renal Disease

* excessive accumulation of metabolic wastes

* severely elevated BUN, creatinine, potassium, and phosphorus levels

* decreased sodium and calcium levels

* decreased hemoglobin level and hematocrit

* fluid retention

A physician uses renal ultrasonography, excretory urography, and renal arteriography to diagnose renal disease. Renal ultrasonography helps the physician visualize renal structures to evaluate the integrity of tissues and vessels. This procedure is safe for patients with renal insufficiency because it doesn't use contrast media.

A physician uses excretory urography to identify the absence or presence of lesions, areas of restricted blood flow, and areas of vascular occlusion. He also may use renal arteriography to evaluate renal blood flow. Excretory urography and renal arteriography require the use of contrast media, placing your patient with renal insufficiency at risk for worsening kidney function.

Treatment for Peripheral Vascular Disease

The treatment of peripheral vascular disease may include drug therapy, surgery, or both. If your patient has peripheral artery occlusive disease, the physician may prescribe pentoxifylline, which is the only effective drug for treating the condition. Pentoxifylline increases erythrocyte flexibility and reduces blood viscosity, thus increasing the oxygenated blood supply to the ischemic muscle.

The physician may prescribe an antihypertensive drug to control your patient's blood pressure. If your patient undergoes arterial bypass surgery for peripheral vascular disease, his physician also may prescribe aspirin and warfarin to maintain graft patency.

To treat peripheral vascular disease, a surgeon may perform patch graft angioplasty. In this procedure, the surgeon opens the occluded artery and removes the atherosclerotic plaque. Then he places a patch over the opening to widen the vessellumen.