Hypertensive nephropathy overview
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Differentiating Hypertensive Nephropathy from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Hypertensive nephropathy is a medical condition referring to damage to the kidney due to chronic high blood pressure.
It should be distinguished from "renovascular hypertension" (I15.0), which is a form of secondary hypertension.
In the kidneys, as a result of benign arterial hypertension, hyaline (pink, amorphous, homogeneous material) accumulates in the wall of small arteries and arterioles, producing the thickening of their walls and the narrowing of the lumens — hyaline arteriolosclerosis. Consequent ischemia will produce tubular atrophy, interstitial fibrosis, glomerular alterations (smaller glomeruli with different degrees of hyalinization - from mild to sclerosis of glomeruli) and periglomerular fibrosis. In advanced stages, renal failure will occur. Functional nephrons have dilated tubules, often with hyaline casts in the lumens.
Pathophysiology
The kidneys may be damaged by or cause hypertension. Evidence from studies on renal transplant recipients and familial studies suggests a genetic component in occurrence of hypertensive nephropathy and nephrosclerosis.
Epidemiology and Demographics
The incident counts and adjusted rates for hypertensive renal disease has been increasing gradually over the past three decades. 25,000 new cases of chronic renal failure attributable to high blood pressure, are diagnosed every year in the US. It has also contributed significantly to the increase in the number of patients undergoing dialysis from renal insufficiency.
Diagnosis
History and Symptoms
Most of the patients with hypertensive nephropathy have no symptoms, although majority give a history of being on medications for chronic hypertension.