Nephrosclerosis Clinical Presentation

Updated: Jun 09, 2021
  • Author: Fernando C Fervenza, MD, PhD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Presentation

History

Patients may present with hypertension, its complications (eg, heart failure, stroke), and/or symptoms of uremia. In most patients with nephrosclerosis, hypertension has been present for many years (usually > 10 y), with evidence of periods of accelerated or poorly controlled blood pressure (BP).

Features suggesting the diagnosis of hypertensive nephrosclerosis are as follows:

  • Black race
  • Hypertensive retinal changes
  • Left ventricular hypertrophy
  • Long-standing or very severe hypertension
  • Proteinuria less than 0.5 g/d
  • Hypertension diagnosed prior to the onset of proteinuria
  • Hypertension preceding kidney dysfunction
  • No evidence of another kidney disease
  • Biopsy findings compatible with the diagnosis
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Physical

Upon physical examination, evidence of hypertension-related target organ damage includes hypertensive changes in the retinal vessels and signs of left ventricular hypertrophy.

On ophthalmologic examination, hemorrhages or exudates are characteristic of accelerated hypertension, and papilledema is a feature of malignant hypertension.

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Causes

No specific causes for hypertensive nephrosclerosis are known.

A gene that predisposes to hypertensive kidney injury has been identified in rats. To date, however, no specific gene associated with hypertensive end-stage renal disease has been identified in humans. It must be noted that the APOL1 gene variant can increase the risk of kidney disease progression in African-American hypertensive patients, but the mechanism by which it causes progression of kidney disease is unknown andwhether the gene variant causes hypertension other than by causing kidney disease first remains unclear.

Correct identification of hypertensive nephrosclerosis susceptibility genes requires accurate hypertensive nephrosclerosis phenotyping. The major  impediment to establishing a reliable hypertensive nephrosclerosis phenotype is the absence of strong clinical criteria to distinguish hypertensive nephrosclerosis from other kidney diseases. Genetic approaches to hypertensive nephrosclerosis require careful scrutiny of clinical diagnoses before assigning phenotypes to study subjects.

See also Pathophysiology.

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