Benign Hypertensive Arteriolar Nephrosclerosis

Benign Hypertensive Arteriolar Nephrosclerosis

Benign hypertensive arteriolar nephrosclerosis is caused by prolonged poorly controlled hypertension which causes deterioration of kidney function.

Pathophysiology

Chronic and poorly controlled hypertension causes damage to the small blood vessels of the kidneys.  It also damages the tissue of the kidneys, such as the glomeruli, renal tubules, and interstitial tissues.  This kidney damage leads to progressive impairment of the function of the kidneys, but only a small percentage of patients with this condition progresses to end-stage renal disease, which necessitates dialysis.

Individuals at high risk of developing benign hypertensive arteriolar nephrosclerosis include the elderly, those with poorly controlled hypertension, and other kidney conditions.

Clinical Features

The most common presenting manifestations include weight loss, dizziness and vomiting, itchiness, sleepiness, and confusion.  There may also be evidence of associated damage in the other organ systems, such as in the eyes and nervous system, due to complications of hypertension.

Diagnosis

In patients suspected to have benign hypertensive arteriolar nephrosclerosis, blood tests may indicate deteriorating kidney function, such as high creatinine and phosphate levels in the blood.  Urinalysis may show the presence of protein in the urine.  Ultrasound may also be performed to exclude other possible causes of a renal disease, and usually shows smaller kidney size.  Kidney biopsy may also be done.

Treatment

The mainstay of therapy is strict blood pressure control.  The blood pressure should be less than 140/90, although the goal should be less than 130/80 in patients with diabetes and chronic kidney problems.  Medications like low-dose thiazide diuretic, ACE inhibitor or angiotensin II receptor blocker, calcium channel blocker, and beta blockers may be given.  Other methods for the management of blood pressure include weight loss, low salt diet, water restriction, and exercise. 

Prognosis

Renal dysfunction progresses slowly.  Only 1 to 2% of patient with benign hypertensive arteriolar nephrosclerosis develop renal failure after 5 to 10 years.

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