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Updated: Feb 28 2019

Hypertensive Nephrosclerosis

  • 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
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