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.

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 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.

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.