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

Diagnostic procedures

• ambulatory blood pressure monitoring
  • discrepancy between ambulatory blood pressure monitoring & office-based monitoring common
  • recommended for assessing success of blood pressure control

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

More general terms

• complication of chronic hypertension
• chronic renal failure (CRF)

More specific terms

• hypertension & proteinuria

Additional terms

• renal artery
• stenosis