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

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

Treatment

Complications

Renal failure
- typically only occurs in patients with concomitant other renal disease