According to the 2011 us renal data system usrds data, in the year 2009, hypertensive nephrosclerosis hn accounted for 28% of patients reaching endstage renal disease esrd. This study aimed to investigate renal outcomes and their predictors in biopsyproven hypertensive nephrosclerosis hn patients and to compare clinicopathological characteristics and prognoses between benign nephrosclerosis bn and malignant nephrosclerosis mn patients. Very high cost pediatric hospitalizations in california, 1987 at risk. Arteriosclerosis, benign and malignant nephrosclerosis and renal artery stenosis.
Benign nephrosclerosis results in small kidneys with finely granular surface and thinned cortex in late stages fig. Schwartz abstract th presenet studies examin the e consequences of the hemodynamic changes associated with nephrosclerosis is a disorder that is usually associated with chronic hypertension. Benign and malignant nephrosclerosis differ in the rate of progressive hardening of renal arterioles. Patients with biopsyproven nephrosclerosis and moderately. The hyalinosis is due to endothelial injury and increased pressure, leading to an insudate of plasma macromolecules. Clinicopathological characteristics and outcomes of. Cortical arteries of the kidney in benign nephrosclerosis are characterized by arterial intimal fibroplasia whereas. Clinical features of benign hypertensive nephrosclerosis at time of renal biopsy. Hypertension is associated with significant morbidity and mortality due both to cardiovascular and renal diseases 15. Systemic and glomerular hypertension and progression of chronic renal disease. Clinical features of benign hypertensive nephrosclerosis. Clinical prognostic factors in biopsyproven benign nephrosclerosis article pdf available in nephrology dialysis transplantation 183. The link between the kidney and hypertension has been considered a villainvictim relationship.
But there was no case, which terminated to death caused by nephrosclerosis. Zucchelli and zuccala, in 6 patients diagnosed as having benign nephrosclerosis, performed a thorough diagnostic workup, including kidney biopsy. Often included are patients with an undiagnosed primary renal disease. Whether benign hypertensive nephrosclerosis bhn causes endstage. Benign hypertension american urological association. It is characterized as benign or malignant depending on the severity and rapidity of the hypertension and arteriolar changes. Nephrosclerosis from childhood to old age, a viewpoint springerlink. Two clinical conditions should be considered separately when the. Quantitative ultrastructural study of afferent and. Patients who develop this condition will have decreased renal reserve and may not cope very well with acute illness and surgical procedures. African americans develop hypertensive ckd nephrosclerosis much more.
The term benign nephrosclerosis is often used to describe the kidney of the benign phase of essential hypertension. The kidney has a major role in the maintenance of blood pressure. Arteriolar vascular smooth muscle cell differentiation in. Progression of renal failure and hypertensive nephrosclerosis. Benign nephrosclerosis is a common condition that is associated with a high morbidity and mortality. Arteriosclerosis, benign and malignant nephrosclerosis and. High blood pressure levels are a wellrecognized feature in chronic renal disease, but the ability of mildtomoderate hypertension to produce renal insufficiency has been questioned. Nephrosclerosis definition of nephrosclerosis by medical. Clinicopathological study on benign nephrosclerosis.
In benign hypertensive nephrosclerosis, the renal outcome depends on the timely initiation of effective therapy, patient adherence, and careful followup. Thankfully this community blesses you with the right information and tools to get through the inevitable tough times and the joy of having people who are in the same situation and helping you as you go. Benign hypertensive nephrosclerosis accounts for 2. Hypertensive kidney disease is a medical condition referring to damage to the kidney due to chronic high blood pressure. This study demonstrated that, despite the finding of benign nephrosclerosis on a renal biopsy specimen, concomitant proteinuria is predictive of a poor prognosis. Clinical prognostic factors in biopsyproven benign nephrosclerosis. Hypertensive nephrosclerosis was long considered a major cause of endstage renal failure esrd. This article is within the scope of wikiproject medicine, which recommends that medicinerelated articles follow the manual of style for medicinerelated articles and that biomedical information in any article use highquality medical sources. Whether benign hypertensive nephrosclerosis bhn causes endstage renal failure esrf is controversial.
Genetic approaches to hypertensive nephrosclerosis require careful scrutiny of clinical diagnoses before assigning phenotypes to study subjects. In addition to the level of blood pressure, other individual fa this site uses cookies. The major impediment to establishing a reliable hypertensive nephrosclerosis phenotype is the absence of strong clinical criteria to distinguish hypertensive nephrosclerosis from other renal diseases. The quantitative ultrastructure of juxtaglomerular arterioles is not known in. As the name suggests, this condition will rarely result in renal failure. Although africanamericans make up only 12 % of the us population, they are fivefold overrepresented among patients with endstage renal disease esrd presumed due to hypertension 1, 2. Data provided by endstage renal disease esrd registries document a progressive and striking increase in the incidence of hypertensionrelated esrd over the years, and its prevalence supports the classic statement that the kidney may be a victim of hypertension. Malignant nephrosclerosis mn is widely regarded as a definite, though increasingly rare, cause of endstage renal disease esrd. The rate of esrd attributed to hypertension has grown 8. Patients with malignant nephrosclerosis typically present with the clinical findings of malignant hypertension, with blood pressure usually higher than 200 mm hg, headaches, blurred vision, dizziness, confusion, and hypertensive encephalopathy. Despite its high prevalence, very little is known about the contribution of arteriolar vascular smooth muscle cells vsmcs to bn.
Significant proteinuria is a common finding and proteinuria within the nephrotic range does occur. As in benign hypertension, the kidney is a major target organ for malignant hypertension. Approximately 60 million people in the united states have hypertension. Benign nephrosclerosis benign nephrosclerosis is the term used for the renal pathology associated with sclerosis hardening of renal arterioles and small arteries. Hypertensive nephrosclerosis in african americans versus. In 65% of patients, hn was the sole histological abnormality associated with renal dysfunction. In most cases the clinical and morphologic distinction between benign and malignant nephrosclerosis is sharp. Approach to the patient with hypertensive nephrosclerosis. Pattern a represents the normal renal autoregulatory responses observed in uncomplicated hypertension and shows the constancy. Systolic blood pressure appears to influence serum creatinine levels. The kidneys appear symmetrically atrophic and there is a reduced nephron mass. As hypertensive nephropathy in patients with early renal damage. Data for biopsyproven hn patients were retrospectively analyzed.
Pdf nephrosclerosis is an umbrella term defining changes in all compartments of the kidney, changes caused by hypertension and by ageing. This study demonstrated that, despite the finding of benign nephrosclerosis on a renal biopsy specimen, concomitant proteinuria is predictive of. Whether benign hypertensive nephrosclerosis bhn causes end stage. Clinicopathological characteristics and outcomes of patients with. In general, the term nephrosclerosis describes a chronic vascular disorder that may eventually lead to renal failure. Renal biopsy in patients with hypertensive nephropathy is safe and feasible. Proteinuria in benign nephrosclerosis jama internal.
Benign nephrosclerosis is common in individuals over the age of 60 while malignant nephrosclerosis is uncommon and affects 15% of individuals with high blood pressure, that have diastolic blood pressure passing mm hg. Between 15% of patients with this condition with develop renal failure at some stage in the disease process. When hypertensive patients are suspected to have nephrosclerosis, evidence of other chronic kidney diseases, such as glomerulonephritis. Renal ablation acutely transforms benign hypertension to. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Kidney disease may affect the functions of the kidneys to the point that impairs this homeostasis control, resulting in elevation of blood pressure. Clinical and pathological analysis of the kidney in patients with. However, on multivariate analysis, poorly controlled diastolic bp and serum creatinine at presentation were the only predictors of renal and patient survival, respectively. Benign nephrosclerosis bn is the most prevalent form of hypertensive damage in kidney biopsies.
Hypertensive nephrosclerosis hn is a common risk factor for endstage renal disease esrd in developed countries, accounting for 3. Benign hypertensive nephrosclerosis may not be a benign. Pdf clinical prognostic factors in biopsyproven benign. Systemic and glomerular hypertension and progression of. By continuing to browse this site you are agreeing to our use of cookies. High blood pressure levels are a wellrecognized feature in chronic renal disease, but the ability of mildtomoderate hypertension to. Quantitative ultrastructural study of afferent and efferent arterioles in iga glomerulonephritis and benign nephrosclerosis springerlink. Final report state policy levers for expanding familycentered medicationassisted treatment evaluation of the medicaid health home option for beneficiaries with. Chronic kidney disease ckd american society of nephrology. Preexisting conditions could affect 1 in 2 americans assessing home health care quality for postacute and chronically ill patients. Please visit the project page for details or ask questions at wikipedia talk.
Hypertensive nephrosclerosis as a relevant cause of. The hypertensiologists view previous article the role of hypertension as a damaging factor for kidney grafts under cyclosporine therapy next article the diagnostic dilemma of hypertensive nephrosclerosis. It is defined by early hyalinosis and later fibrosis of renal arterioles. Persistent proteinuria was found only in diabetic nephrosclerosis. Term benign hypertension is usually slight to moderate severity and of long duration. Benign essential hypertension is characterized by moderate elevation of blood pressure diastolic pressure of 90 to 120 mm hg or occasionally higher than this, cardiac.
Benign nephrosclerosis seldom is associated with significant proteinuria or reduced renal function. Benign nephrosclerosis an overview sciencedirect topics. Affected patients rarely have a kidney biopsy and their diagnoses therefore remain uncertain. Different populations have different risks and different consequences of hypertension. One reason for this is the lack of biopsy evidence confirming the clinical diagnosis in. Arteriolosclerosis frequently occurs in iga nephritis igan, and it is the hallmark of benign nephrosclerosis bns. The present studies examine the consequences of the hemodynamic changes associated with approximately 56 renal ablation in the spontaneously hypertensive rat shr, a strain that normally does not exhibit evidence of vascular andor glomerular injury until late in life despite significant hypertension. The group of chronic hypertensions that ends through some factor other than renal insufficiency almost always presents the well defined histologic picture of simple renal. Benign nephrosclerosis refers to the renal changes most commonly occurring in association with longstanding hypertension. The dilemma of nephrosclerosis the link between the kidney and hypertension has been considered a villainvictim relationship. In contrast, it remains uncertain whether benign nephrosclerosis bn consequent to essential hypertension can also cause esrd.
It is termed benign because it rarely progresses to clinically significant chronic kidney disease or kidney failure. Clinicopathological study on benign nephrosclerosis observed in the autopsy cases in hisayama study. Renal ablation acutely transforms benign hypertension to malignant nephrosclerosis in hypertensive rats anil k. Mesangioproliferative glomerulonephritis of varying severity was found by renal biopsy in 86. Lessons from the us, japan, and mexico article pdf available in nephrology dialysis transplantation 159. Benign nephrosclerosis is the term applied to the renal changes seen with longstanding benign hypertension. Pdf whether benign hypertensive nephrosclerosis bhn causes endstage. Benign nephrosclerosis bn, defined as isolated arteriolar hyalinosis andor intimal fibrosis, was found in 18 hn patients 22%, whereas malignant nephrosclerosis mn, denoted mainly by myointimal cell proliferation, appeared in 35 hn patients 43%. Global glomerulosclerosis was categorized as either the solidified type a, with solidification of the glomerular tuft, or the obsolescent type b with global sclerosis with retraction of the tuft and bowmans space occupied by collagenous material.
Hypertensive nephrosclerosis in african americans versus caucasians. Microscopically, there is vascular wall medial thickening with frequent afferent arteriolar hyaline deposits figs. A patient with benign hypertension may subsequently develop malignant hypertension. Hypertensive renal damage has become one of the most important causes of endstage renal failure esrf in western countries. Pdf benign hypertensive nephrosclerosis researchgate. Clinical features of benign hypertensive nephrosclerosis at time of.
164 1051 1595 601 992 498 304 509 809 3 607 482 337 982 1313 418 180 1171 1133 1359 1514 408 319 376 1487 989 950 1032 1473 263 857 451 177 539 716 416 1327 680 597 657 802 719 273 1025 466