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Hypertensive Arteriolar Nephrosclerosis

By

Zhiwei Zhang

, MD, Loma Linda University

Last full review/revision Mar 2021| Content last modified Mar 2021
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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.

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 can also damage the heart, causing heart failure. Hypertension also increases the risk of heart attack and stroke.

Hypertensive nephrosclerosis progresses to end-stage renal disease (severe chronic kidney disease) in only a small percentage of people. However, because chronic hypertension and nephrosclerosis are common, hypertensive nephrosclerosis is one of the most common causes of end-stage renal disease.

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

  • Routine blood tests

  • Other tests to detect damage to other organs and other causes of kidney damage

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.

Treatment

  • Control of blood pressure

Treatment involves strict blood pressure control. Most people need to take a combination of drugs, including an angiotensin II receptor blocker (ARB) 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.

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

More Information

The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  • American Association of Kidney Patients (AAKP): AAKP improves the lives of patients through education, advocacy, and promotion of a sense of community among patients with kidney disease.

  • American Kidney Fund (AKF): AKF provides information about kidney disease and kidney transplant, needs-based financial assistance to help manage medical expenses, webinars for medical professionals, and opportunities for advocacy.

  • National Kidney Foundation (NKF): This clearinghouse provides everything from information on the basics of kidney function to access to treatment and support for people with kidney disease, continuing medical education courses, and research opportunities and grant support for medical professionals.

  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): General information on kidney diseases, including research discoveries, statistics, and community health and outreach programs.

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