Hypertensive Nephrosclerosis: Pathological Changes and Overlap with Diabetic Nephropathy

Area of Science:

• Nephrology
• Pathology
• Internal Medicine

Background:

• Hypertensive nephrosclerosis (HN) and diabetic nephropathy (DN) are leading causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD).
• Both conditions present overlapping clinical and histopathological features, complicating accurate diagnosis, especially with concurrent diabetes and hypertension.

Purpose of the Study:

• To synthesize current evidence on the pathophysiology, histopathology, diagnostic criteria, and therapeutic implications of HN and DN.
• To emphasize areas of morphological and clinical overlap between these two major causes of CKD.

Main Methods:

• This narrative review synthesizes existing scientific literature.
• Evidence on pathophysiology, histopathology, diagnostics, and therapeutics of HN and DN was reviewed.

Main Results:

• HN results from sustained hypertension-induced vascular injury, leading to ischemic changes.
• DN is driven by hyperglycemia, causing mesangial expansion, GBM thickening, and arteriolar hyalinosis.
• Mixed lesions are common, particularly in patients with long-standing type 2 diabetes and hypertension.

Conclusions:

• Accurate differentiation between HN and DN is clinically significant for guiding disease-specific interventions.
• Targeted therapies for DN include glycemic control and pharmacotherapies, while HN management focuses on vascular risk reduction.
• Future advancements in biomarkers, imaging, and genomics may enable earlier, noninvasive diagnosis of these conditions.