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hypertensive nephropathy; hypertensive nephrosclerosis; hypertensive kidney disease

Etiology: - chronic hypertension Epidemiology: - 2nd most common cause of end-stage renal disease Pathology: - atherosclerosis with increased pulse pressure down as far as the afferent arterioles - hyaline arteriolosclerosis (hyaline accumulation in the wall of small arteries & arterioles with wall thickening & occlusion - loss of renal autoregulation with glomerular hypertrophy, hyperfiltration, & focal segmental glomerulosclerosis - resultant ischemia results in - tubular atrophy - interstitial fibrosis - glomerulosclerosis - periglomerular fibrosis - renal failure - functional nephrons have dilated tubules, often with hyaline casts in the lumens Clinical manifestations: - edema - hypertension Laboratory: - urinalysis: proteinuria & hematuria Special laboratory: - ambulatory blood pressure monitoring - discrepancy between ambulatory blood pressure monitoring & office-based monitoring common [4] - recommended for assessing success of blood pressure control [4] Management: - also see chronic hypertension - stage 1 hypertension - thiazide diuretic generally agent of choice, especially in black patients - add ACE inhibitor if microalbuminuria - ACE inhibitor alone for white person with microalbuminuria - calcium channel blocker is another option - stage 2 hypertension - start with 2 agents - thiazide diuretic + ACE inhibitor if microalbuminuria - ACE inhibitors may be less effective antihypertensives in black persons - blood pressure goal < 140/90 mm Hg - if BP at goal, no reason to increase ACE inhibitor unless urine albumin/creatinine is > 300 mg/g [5]

Related

renal artery stenosis

Specific

hypertension & proteinuria

General

complication of chronic hypertension chronic renal failure (CRF)

References

  1. Wikipedia: Hypertensive nephropathy http://en.wikipedia.org/wiki/Hypertensive_nephropathy
  2. Hill GS. Hypertensive nephrosclerosis. Curr Opin Nephrol Hypertens. 2008 May;17(3):266-70 PMID: 18408477
  3. Fervenza FC and Batuman V Nephrosclerosis http://emedicine.medscape.com/article/244342-overview
  4. Gorostidi M et al. Differences between office and 24-hour blood pressure control in hypertensive patients with CKD: A 5,693-patient cross- sectional analysis from Spain. Am J Kidney Dis 2013 Aug; 62:285 PMID: 23689071
  5. Medical Knowledge Self Assessment Program (MKSAP) 17, 18., American College of Physicians, Philadelphia 2015, 2018
  6. Appel LJ, Wright JT Jr, Greene T et al Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med. 2010 Sep 2;363(10):918-29. PMID: 20818902 Free PMC Article
  7. Gargiulo R, Suhail F, Lerma EV. Hypertension and chronic kidney disease. Dis Mon. 2015 Sep;61(9):387-95. Review. PMID: 26328515