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Pathology - Hypertensive Nephropathy
Definition: Chronic renal disease associated with hypertension. Epidemiology: • Common causes of chronic kidney disease.
Aetiology • Hypertension
Pathogenesis • Two pathophysiological explanations have been proposed and may not be mutually exclusive. • Arteriole constriction leads to glomerular ischemia and scarring, while glomerular hypertension produces glomerular hyperfiltration and eventual glomerulosclerosis. Presentation: Renal failure and proteinuria in a long-standing hypertensive with no additional causes of renal illness. • Additional indicators of hypertension, such as left ventricular hypertrophy, may also be present.
Macroscopy: • Both kidneys are shrunken, with finely granular cortical surfaces. Histopathology • Afferent arterioles have hyaline deposits. • Medial hypertrophy and intimal thickening are seen in interlobular and larger arteries. • Glomeruli may show wrinkling and shrinkage followed by scarring of the whole tuft or enlargement of the tuft followed by segmental scarring. • These pathological features are referred to as nephrosclerosis, which simply means hardening of the kidney.
The appearance of nephrosclerosis may not necessarily indicate hypertensive nephropathy, as similar alterations might occur with aging or diabetes. However, a kidney biopsy can confirm a diagnosis of hypertensive nephropathy if the clinical presentation matches.
Prognosis: • Chronic kidney disease tends to progress. • Aggressive blood pressure control can reduce the deterioration in renal function.
Definition: Chronic renal disease associated with hypertension. Epidemiology: • Common causes of chronic kidney disease.
Aetiology • Hypertension
Pathogenesis • Two pathophysiological explanations have been proposed and may not be mutually exclusive. • Arteriole constriction leads to glomerular ischemia and scarring, while glomerular hypertension produces glomerular hyperfiltration and eventual glomerulosclerosis. Presentation: Renal failure and proteinuria in a long-standing hypertensive with no additional causes of renal illness. • Additional indicators of hypertension, such as left ventricular hypertrophy, may also be present.
Macroscopy: • Both kidneys are shrunken, with finely granular cortical surfaces. Histopathology • Afferent arterioles have hyaline deposits. • Medial hypertrophy and intimal thickening are seen in interlobular and larger arteries. • Glomeruli may show wrinkling and shrinkage followed by scarring of the whole tuft or enlargement of the tuft followed by segmental scarring. • These pathological features are referred to as nephrosclerosis, which simply means hardening of the kidney.
The appearance of nephrosclerosis may not necessarily indicate hypertensive nephropathy, as similar alterations might occur with aging or diabetes. However, a kidney biopsy can confirm a diagnosis of hypertensive nephropathy if the clinical presentation matches.
Prognosis: • Chronic kidney disease tends to progress. • Aggressive blood pressure control can reduce the deterioration in renal function.
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