Hypertensive Nephrosclerosis: Causes, Diagnosis and Treatment

Index

What is it?

NH is a disorder that is usually associated with chronic hypertension. In addition to the level of blood pressure, it is clear that other individual factors are involved.

As an example, black patients have an approximate eight times the risk of end-stage renal disease, this risk can persist even with the control of blood pressure.

Causes

The specific causes for hypertensive nephrosclerosis are not known. The correct identification of susceptibility genes (hypertensive nephrosclerosis) requires a precise phenotype.

The main impediment to the establishment of a reliable phenotype is the absence of strong clinical criteria to distinguish hypertensive nephrosclerosis from other renal diseases.

Genetic approaches require a careful examination of clinical diagnoses before assigning the phenotypes of the study subjects.

Although low birth weight and bias in diagnosis based on the patient’s race may be involved, the recent recognition of an association between two variant independent sequences in the APOL1 gene on chromosome 22 and kidney disease in African-Americans, including focal segmental glomerular sclerosis and related hypertension, provides a physiopathological mechanism much more likely and suggests that hypertensive nephrosclerosis in blacks and whites can cause different diseases.

In addition, the histological features of hypertensive nephrosclerosis can be observed in patients with normal blood pressure.

NH diagnosis

The diagnosis of hypertensive nephrosclerosis depends on the exclusion of other primary renal diseases.

A past history, family history, the search for signs of organ damage, such as left ventricular hypertrophy and retinal alterations in hypertensive patients, urine microscopy and the performance of renal ultrasound should establish the diagnosis, with additional tests for the diseases or vasculitis if indicated.

Treatment of Hypertensive Nephrosclerosis

The obvious pressing need is to be able to identify, from the large number of patients with essential hypertension, those destined to develop, or in the course of advancing, towards terminal kidney disease.

Black race, increased age, family history of end-stage renal disease, and microalbuminuria are all potential candidates as risk factors.

Unlike diabetes, it is not yet established that microalbuminuria is a harbinger of the development of renal failure secondary to the primary disease, in this case, hypertension, although there is some evidence of preliminary support.

It is established, however, that microalbuminuria is very associated with cardiovascular risk factors such as left ventricular hypertrophy, hyperlipidemia.

Although the experts can not yet say whether microalbuminuria represents the first effects of hypertension on glomerular structure or function, the association with cardiovascular risks justifies the intensification of antihypertensive therapy and the normalization of blood pressure.