Hypertensive nephropathy overview
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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 chronic medical condition, characterized by kidney injury due to long-standing high blood pressure.
- It should be distinguished from "renovascular hypertension", which is a type of secondary hypertension.
Pathophysiology
- In the kidneys, as a result of benign arterial hypertension, hyaline (pink, amorphous, homogeneous material) accumulates in the wall of small arteries and arterioles, leading to thickening of arterial walls and narrowing of the lumens — hyaline arteriolosclerosis. Consequently, tubular atrophy and interstitial fibrosis will occur.
- Glomerular alterations (smaller glomeruli with different degrees of hyalinization - from mild to severe glomerulosclerosis) and podocyte loss can increase the endothelial permeability and filtration of remaining glomerules, leading to microalbuminuria and development of CKD
- Some studies suggest a genetic component in the development of hypertensive nephropathy and nephrosclerosis.
Epidemiology and Demographics
- The incidence rate for hypertensive kidney disease has been increasing gradually over the past three decades.
- Annually, 25,000 new cases of CKD associated with hypertension, are diagnosed in the US.
- Hypertension is known as the second leading cause of ESRD.
Diagnosis
History and Symptoms
- Most of the patients with hypertensive nephropathy have no symptoms until kidney failure occurs.