Hypertensive nephropathy refers to renal damage from long-standing, uncontrolled hypertension. It can start off as benign nephrosclerosis but can progress into chronic kidney disease and end-stage renal failure if not managed appropriately.
It is not a major cause of mortality in hypertensive individual when compared to some of the other hypertensive complications such as CVAs, CCF, IHD etc.
Pathophysiology
Long standing hypertension results in reduced blood flow to the glomeruli due to atherosclerosis and plaque deposition within arteries. It leads to narrowing of the afferent arterioles and there is a progressive reduction in the amount of blood reaching the nephrons which causes chronic ischaemia. Nephrons then g slowly convert into a mass of hyaline tissue (hyaline arteriosclerosis) resulting in nephrosclerosis (hardening of the kidney).
A decrease in renal perfusion also decreases GFR resulting in RAAS activation and further raised blood pressure. This cycle continues and renal function declines further.
😷 Presentation
Initially it is asymptomatic but clinical findings include:
- Microalbuminuria
- Raised serum urea
- Decreased GFR
- Signs and symptoms of CKD - such as oedema, SOB, tiredness, weight loss, haematuria, dizziness.
🔍 Investigations
The gold standard is histology and morphological examination.
Urine dipstick and U&Es may show signs of kidney disease (reduced GFR, raised urea levels, microalbuminuria), haematuria may also be seen.
🧰 Management
Management of underlying hypertension and if it progresses to CKD then manage the CKD (the management for hypertension and CKD can be found in their corresponding CCCs).