Hypertensive renal disease (hypertensive nephrosclerosis)

Introduction

Hypertension is considered one of the leading causes of kidney disease, while kidney disease is the most common cause of secondary hypertension. In Norway hypertension listed as the most common cause of kidney failure in end stage (stage 5D), accounting for 1/3 of the patients. The incidence of hypertensive renal disease (hypertensive nephrosclerosis) has risen sharply in the Western world over the past decade and partly explained by improved survival among cardiac karsyke patients now survive long enough to get kidney complications.

Causes

Microalbuminuria is an early sign of organ damage by hypertension. This is thought to represent a universal damage of the endothelium throughout kartreet. Both glomerular hypertension, which provides progressive glomerular injury, and tubular ischemia, providing tubulointerstitial damage, is thought to help the histopathological changes seen in hypertensive nephrosclerosis.

Clinical presentation

Hypertensive nephrosclerosis is considered an organ damage from prolonged hypertension. Established atherosclerotic disease and ventre ventricular hypertrophy is often present and the probability increases with increasing age. Proteinuria is usually sparse (<0.5 g / day), urinary sediment is peaceful, but hyaline and granular cylinders may occur. Other kidney disease should be suspected if proteinuria is over 1 g / day or there are active urine sediment. Kidney biopsy gives the final diagnosis, but in many patients the diagnosis is clinically when risks of a biopsy is considered to be higher than the benefit of verifying the diagnosis by a biopsy.

Histopathology

It is seen hyaline arteriolosklerose in benign hypertension and hyperplastic arteriolosklerose by severe hypertension.

Course and treatment

Hypertensive nephrosclerosis progressive classical slowly. There is no specific treatment. Blood Pressure Treatment with target blood pressure 140/90 mmHg are like at all other kidney disease the most important measure to limit the progression of kidney disease. ACE inhibitor or AII blocks are preferred antihypertensive drugs if they are tolerated.

As the condition progresses slowly and most patients have etablertaterosklerotisk disease, the vast majority of patients do not have time to develop renal failure in the end stage. Optimal cardiovascular secondary prophylaxis is indicated in this high-risk population.

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