Snapshot A 42-year-old African American woman presents to her physician’s office for an annual visit. She has a long-standing history of hypertension and is currently not on any medication. On routine laboratory examination, she is found to have a creatinine of 1.5 mg/dL. Urine studies reveal mild proteinuria. Her physician prescribes lisinopril for her hypertension and likely renal disease. Introduction Clinical definition this represents renal sclerosis nephrosclerosis is associated with chronic hypertension this is distinct from malignant hypertension or malignant nephrosclerosis Epidemiology demographics common in people of African descent risk factors hypertension chronic renal disease Pathogenesis involves the vasculature, glomeruli, tubules, and interstitium of the kidney chronic hypertension causes medial and intimal hypertrophy this causes narrowed vessels and ischemia ischemic damage to kidneys also can cause glomerulosclerosis vessel walls are further damaged by hyaline-like material deposition interstitial nephritis is often found on biopsy and the exact mechanism is unknown Presentation Symptoms hypertension precedes proteinuria or renal insufficiency Physical exam typically benign Studies Labs ↑ creatinine ↑ blood urea nitrogen ↑ uric acid Urinalysis few casts typically benign mild proteinuria (< 1 g/day) Gross specimen cobblestone appearance Diagnostic criteria hypertension precedes proteinuria or renal insufficiency no other causes of renal disease biopsy is not necessary Differential Malignant nephrosclerosis Treatment Medical angiotensin converting enzyme (ACE) inhibitors indications for all patients with hypertension-associated nephrosclerosis angiotensin II receptor blockers indications if ACE inhibitors are contraindicated Complications Renal failure typically only occurs in patients with concomitant other renal disease