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Related Experiment Videos

The link between hypertension and nephrosclerosis

B I Freedman1, S S Iskandar, R G Appel

  • 1Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1053.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|February 1, 1995
PubMed
Summary

Nephrosclerosis, or kidney hardening, is often misattributed to hypertension. This review suggests many cases involve other intrinsic kidney diseases or inherited factors, not just high blood pressure.

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Area of Science:

  • Nephrology
  • Pathology
  • Hypertension Research

Background:

  • Nephrosclerosis is defined as kidney hardening due to scarring and collagenous tissue replacement.
  • It primarily affects the renal microvasculature, secondarily involving glomeruli and interstitium.
  • Hypertension is often cited as a cause of nephrosclerosis and end-stage renal disease (ESRD).

Purpose of the Study:

  • To critically evaluate the association between hypertension and nephrosclerosis.
  • To explore alternative etiologies for renal disease currently labeled as hypertensive nephrosclerosis.
  • To investigate the role of genetic and environmental factors in progressive renal failure.

Main Methods:

  • Literature review and critical analysis of existing medical data.

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  • Examination of clinical presentation and diagnostic criteria for nephrosclerosis.
  • Consideration of epidemiological data, including racial disparities in ESRD classification.

    • Main Results:

    • The link between mild to moderate hypertension and nephrosclerosis/ESRD is often circumstantial.
    • Serum creatinine levels infrequently rise in patients with long-standing mild to moderate hypertension.
    • African-American patients are disproportionately diagnosed with hypertensive nephrosclerosis.
    • Alternative diagnoses like intrinsic renal diseases, renal artery stenosis, or unrecognized accelerated hypertension are proposed.
    • Familial clustering of ESRD suggests a potential role for inherited factors.

    Conclusions:

    • Many diagnoses of hypertensive nephrosclerosis may be incorrect, masking other renal pathologies.
    • Mild to moderate hypertension alone is likely an uncommon cause of nephrosclerosis.
    • Further research into genetic and environmental factors is needed to understand susceptibility to progressive renal disease.