Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Chronic systemic hypertension before the onset of proteinuria Declining renal function; proteinuria; anemia Renal biopsy evidence of arteriolonephrosclerosis, glomerulosclerosis, tubular atrophy, interstitial fibrosis, and inflammatory infiltrates +++ GENERAL CONSIDERATIONS ++ The cause of hypertensive nephrosclerosis is still unknown and is not always prevented by the treatment of hypertension Thus, there is debate about optimal blood pressure levels to prevent this complication Hypertensive nephrosclerosis is one of the most common causes of end-stage renal disease Once initiated, the condition is progressive It is more common in males of African origin Once renal disease ensues, it can cause hypertension +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Typically nonspecific symptoms of hypertension +++ PHYSICAL EXAM FINDINGS ++ Elevated blood pressure without a nocturnal dip Retinopathy may be seen Left ventricular lift or heave +++ DIFFERENTIAL DIAGNOSIS ++ Unless renal biopsy is performed, hypertensive nephrosclerosis is a diagnosis of exclusion Parenchymal renal disease Renovascular hypertension with renal insufficiency +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Urinalysis: hyaline and granular casts, microalbuminuria Elevated serum creatinine, uric acid Anemia +++ ELECTROCARDIOGRAPHY ++ Left ventricular and atrial hypertrophy +++ IMAGING STUDIES ++ Renal ultrasound may show small kidneys with cortical thinning +++ DIAGNOSTIC PROCEDURES ++ Renal biopsy is diagnostic +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Hypertension that is difficult to control Suspected cardiac disease +++ HOSPITALIZATION CRITERIA ++ Renal failure +++ MEDICATIONS ++ Twenty-four-hour blood pressure < 130/85 mm Hg with multiple drugs as necessary Sodium restriction and diuretics Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are best first therapy +++ THERAPEUTIC PROCEDURES ++ Renal dialysis if necessary +++ MONITORING ++ ECG and blood pressure in hospital +++ ONGOING MANAGEMENT +++ FOLLOW-UP ++ Depends on blood pressure control +++ COMPLICATIONS ++ End-stage renal disease +++ PROGNOSIS ++ Renal dialysis rate is 5–10% per year Survival is 85% at 5 years and 50% at 10 years The most common cause of death is cardiovascular disease +++ PREVENTION ++ Adequate blood pressure control; optimal blood pressure levels have not been determined, but < 135/85 mm Hg is recommended +++ RESOURCES +++ PRACTICE GUIDELINES ++ Although ACE inhibitors or ARBs are ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth