Simple illnesses were delayed until they became complicated, and I was hospitalized 6 times in one year.

This is the 5249th article of Da Yi Xiao Hu

Mr. Gao, 74 years old, has been hospitalized 6 times before the end of this year. First, he was hospitalized 3 times for cerebral infarction, carotid artery stenosis, vertebral artery occlusion, and 3 stents were placed in the carotid artery; then he was hospitalized twice for myocardial infarction. Because all three blood vessels of the heart were blocked and stents could not be placed, he had to undergo coronary artery bypass grafting surgery; now he is admitted to the nephrology department because of renal failure and heart failure, and it is estimated that he will have to deal with the nephrology department frequently in the future.

Figure 1: Blood creatinine is elevated, and endogenous creatinine clearance (relative to glomerular filtration rate) is 35.5 ml/min, which is already moderate renal failure.

Figure 2: Urine protein quantification is 8.23g/d. 3.5g/d or more is heavy proteinuria, indicating that the glomerular filtration membrane is severely damaged.

Figure 3: High glycosylated hemoglobin indicates poor blood sugar control in the recent period.

Figure 4: Heavy proteinuria leading to hypoproteinemia.

Figure 5: Heavy proteinuria

Figure 6: NT-proBNP is significantly elevated, indicating severe heart failure.

Figure 7: High blood creatinine and low carbon dioxide binding capacity indicate renal failure and acidosis.

Figure 8: Low hemoglobin and renal anemia caused by chronic renal failure.

Figure 9: Arteriosclerosis, stenosis, and occlusion of the left lower limb arteries are consistent with lesions in the cerebral arteries and coronary arteries.

Figure 10: Arteriosclerosis, stenosis and occlusion of the right lower limb arteries are consistent with lesions in the cerebral arteries and coronary arteries.

What was the reason that caused problems with his heart, brain and kidneys?

His illness seems complicated, but the cause is actually very simple: high blood pressure and diabetes. He didn't take care of them in the early stages, and they eventually developed into complications.

Myocardial infarction, cerebral infarction, and renal failure are actually the same disease, called atherosclerotic cardiovascular disease, or ASCVD. Hypertension and diabetes can damage the vascular endothelium, leading to atherosclerosis, vascular stenosis, and ischemic necrosis of the tissues supplied by the blood vessels. If atherosclerosis occurs in the cerebral arteries, the result is cerebral infarction; atherosclerosis occurs in the coronary arteries, the result is myocardial infarction; the glomerulus is composed of microvessels, and glomerular arteriosclerosis and microvascular lesions caused by diabetes result in hypertensive nephropathy, diabetic nephropathy, and renal failure.

This is how cardiovascular, cerebral and kidney complications caused by hypertension and diabetes are formed.

High blood pressure or diabetes alone can cause huge damage to the heart, brain and kidneys. If both exist at the same time, it will make the situation even worse.

In addition, coronary heart disease and myocardial ischemia lead to heart failure, and heart failure leads to insufficient blood perfusion to the kidneys, which easily leads to renal failure; and high blood pressure, anemia, calcium and phosphorus metabolism disorders caused by renal failure lead to heart failure. The failure of one organ, the heart and the kidney, induces the failure of the other organ, and the two harm and aggravate each other. This situation is called cardiorenal syndrome.

This old man has had hypertension and diabetes for more than ten years. He did not receive treatment in the past few years and has not taken medication regularly in recent years. His blood pressure and blood sugar have never been normal. Blood vessels throughout his body have become diseased under the long-term attack of blood pressure and blood sugar, and finally damaged important organs such as the heart, brain, and kidneys.

If he had controlled his blood pressure and blood sugar to the standard earlier, he might have been able to reduce or avoid the occurrence of arteriosclerosis, and also reduce or avoid the occurrence of cardiovascular, cerebrovascular and kidney complications.

Dr. Li Qing once again reminded everyone that hypertension and diabetes are minor illnesses if treated early, but they become major illnesses if left untreated. Therefore, if high blood pressure and high blood sugar are found, they must be strictly controlled and must be brought up to standard.

1. Improve your lifestyle: reduce salt intake, lose weight, exercise, quit smoking, limit alcohol consumption, and don't stay up late. Healthy people have one thing in common: self-discipline. If your lifestyle is too willful, you will pay the price for future diseases.

2. If improving your lifestyle still cannot bring your blood pressure and blood sugar under control, don’t refuse medication.

3. Not only should medication be used, but blood pressure and blood sugar should also be controlled to meet the standard. It is generally recommended to control blood pressure below 130/80 mmHg and blood sugar within the normal range. In a sense, failure to meet the standard is equivalent to no treatment.

4. Try to choose antihypertensive and hypoglycemic drugs with organ protection, such as sartan or pril antihypertensive drugs, dihydrotestosterone antihypertensive drugs, levitra antihypertensive drugs, peptide antihyperglycemic drugs, etc., which can not only control blood pressure and blood sugar, but also protect the heart, brain and kidneys.

Author: Tianjin University TEDA Hospital

Department of Nephrology Li Qing, Chief Physician