Hypertensive arteriolar nephrosclerosis results when chronic hypertension Hypertension Hypertension is sustained elevation of resting systolic blood pressure (≥ 130 mm Hg), diastolic blood pressure (≥ 80 mm Hg), or both. Hypertension with no known cause (primary; formerly, essential... read more damages small blood vessels, glomeruli, and tubulointerstitial tissues. As a result, progressive chronic kidney disease Chronic Kidney Disease Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia... read more develops.
Hypertensive arteriolar nephrosclerosis progresses to end-stage renal disease in only a small percentage of patients. However, because chronic hypertension and hypertensive nephrosclerosis are common, hypertensive arteriolar nephrosclerosis is one of the most common diagnoses in patients with end-stage renal disease. It is often described as benign to distinguish it from malignant arteriolar nephrosclerosis, which is a synonym for hypertensive emergency Hypertensive Emergencies A hypertensive emergency is severe hypertension with signs of damage to target organs (primarily the brain, cardiovascular system, and kidneys). Diagnosis is by blood pressure (BP) measurement... read more .
Risk factors include
Poorly controlled moderate to severe hypertension
Black people are at increased risk; it is unclear if the risk is increased because poorly treated hypertension is more common among Black people or because they are more genetically susceptible to hypertension-induced renal damage.
Symptoms and Signs of Hypertensive Arteriolar Nephrosclerosis
Symptoms and signs of chronic kidney disease Symptoms and Signs Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia... read more , such as anorexia, nausea, vomiting, pruritus, somnolence or confusion, weight loss, and an unpleasant taste in the mouth, may develop. Signs of hypertension-related end-organ damage may occur in the vasculature of the eyes and in the skin, central nervous system, and periphery.
Diagnosis of Hypertensive Arteriolar Nephrosclerosis
History of hypertension
Blood tests indicating renal failure
Signs of hypertensive end-organ damage
No other cause of chronic kidney disease
The diagnosis may be suspected when routine blood tests indicate deteriorating renal function (eg, elevated creatinine and blood urea nitrogen, hyperphosphatemia) in a hypertensive patient. Diagnosis is usually inferred because of the history and evidence of hypertension-related end-organ damage (eg, retinal changes, left ventricular hypertrophy) on physical examination. Hypertension should be present before onset of proteinuria and renal failure, and there should be no other clinically suspected cause of renal failure.
Urine testing should not suggest other causes of renal failure (eg, glomerulonephritis, hypertensive emergency). On urinalysis, there should be few cells or casts in the sediment, and protein excretion is usually < 1 g/day (it is occasionally higher and in the nephrotic range).
Ultrasonography should be done to exclude other causes of renal failure. It may show that kidney size is reduced. Renal biopsy is done only if the diagnosis remains unclear.
Treatment of Hypertensive Arteriolar Nephrosclerosis
Blood pressure (BP) control
Treatment involves strict BP control Treatment Hypertension is sustained elevation of resting systolic blood pressure (≥ 130 mm Hg), diastolic blood pressure (≥ 80 mm Hg), or both. Hypertension with no known cause (primary; formerly, essential... read more . The current recommendation of BP goal is 120 to 130/< 80 mm Hg for most patients (1 Treatment reference Hypertensive arteriolar nephrosclerosis is progressive renal impairment caused by chronic, poorly controlled hypertension. Symptoms and signs of chronic kidney disease may develop (eg, anorexia... read more ). Most experts suggest using an angiotensin II receptor blocker (ARB) or an angiotensin-converting enzyme (ACE) inhibitor for patients who have proteinuria. Calcium channel blockers and thiazide diuretics can be used as first-line medications; most patients require combination therapy for BP control. Weight loss, exercise, and salt and water restriction also help control BP. Chronic kidney disease Prognosis Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia... read more should be managed.
1. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group: KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int 99(3S):S1-S87, 2021. doi: 10.1016/j.kint.2020.11.003
Prognosis for Hypertensive Arteriolar Nephrosclerosis
Prognosis usually depends on adequacy of blood pressure control and degree of renal failure. Usually, renal impairment progresses slowly; after 5 to 10 years, only 1 to 2% of patients develop clinically significant renal dysfunction.
Chronic hypertension can cause hypertensive arteriolar nephrosclerosis, resulting in chronic kidney disease and, infrequently, end-stage renal disease.
Suspect the diagnosis if chronic hypertension precedes onset of renal insufficiency.
Do ultrasonography to check for other causes of renal failure.
Treat most patients with an ACE inhibitor or ARB, and possibly other medications, to control BP.
Drugs Mentioned In This Article
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