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Benign Hypertensive Arteriolar Nephrosclerosis

by Zhiwei Zhang, MD

Benign hypertensive arteriolar nephrosclerosis is progressive kidney damage caused by long-standing, poorly controlled high blood pressure (hypertension).

  • The person may develop symptoms of chronic kidney disease such as loss of appetite, nausea, vomiting, itching, and confusion.

  • The person may also have symptoms related to damage to other organs caused by the high blood pressure.

  • Doctors make the diagnosis based on the person's history of high blood pressure as well as ultrasonography and blood test results.

  • Treatment is strict control of blood pressure.

Benign hypertensive arteriolar nephrosclerosis results when long-standing (chronic) hypertension damages tissue in the kidneys, including small blood vessels, glomeruli, renal tubules, and interstitial tissues. As a result, progressive chronic kidney disease develops. Chronic hypertension (see High Blood Pressure) can also damage the heart, causing heart failure. Hypertension also increases the risk of heart attack and stroke.

Benign nephrosclerosis progresses to end-stage renal disease (severe chronic kidney disease) in only a small percentage of people. However, because chronic hypertension and benign nephrosclerosis are common, benign nephrosclerosis is one of the most common causes of end-stage renal disease. It is termed benign to distinguish it from certain more severe disorders affecting kidney blood vessels.

Risk factors include older age, poorly controlled moderate to severe high blood pressure, and other kidney disorders (for example, diabetic nephropathy). Blacks are at increased risk, but it is unclear if the risk is increased because poorly treated high blood pressure is more common among blacks or because blacks are more genetically susceptible to kidney damage caused by high blood pressure.

Symptoms

Symptoms of chronic kidney disease, such as loss of appetite, nausea, vomiting, itching, sleepiness or confusion, weight loss, and an unpleasant taste in the mouth, may develop.

Diagnosis

The diagnosis may be suspected when routine blood tests indicate deteriorating kidney function in a person with high blood pressure. Doctors make the diagnosis when the physical examination or test results show evidence of organ damage caused by high blood pressure. Such damage may be changes in the retina observed with an ophthalmoscope or evidence of heart abnormalities detected with electrocardiography (ECG) or echocardiography.

Urine testing should be done to detect other disorders that may cause kidney disease.

Ultrasonography should be done to exclude other causes of kidney damage. It may show that kidney size is reduced. Kidney biopsy is done only if the diagnosis remains unclear.

Prognosis

Prognosis usually depends on how well blood pressure is controlled and degree of kidney damage. Usually, kidney damage progresses slowly. After 5 to 10 years, only 1 to 2% of people develop significant kidney dysfunction.

Treatment

Treatment involves strict blood pressure control. Most people need to take a combination of drugs, including an angiotensin II receptor blocker or an angiotensin converting enzyme (ACE) inhibitor, and possibly calcium channel blockers, thiazide diuretics, or beta-blockers. Weight loss, exercise, and salt and water restriction also help control blood pressure. Chronic kidney disease should be managed by restricting fluid and salt intake and sometimes dialysis.