Hypertensive Nephrosclerosis (Study Outline) 1. Background…
Hypertensive Nephrosclerosis (Study Outline) 1. Background Definition: Chronic kidney damage resulting from long-standing hypertension leading to progressive nephron loss and CKD. Pathophysiology: Chronic systemic hypertension → hyaline arteriolosclerosis of afferent/efferent arterioles → ischemic injury to nephrons. Leads to glomerulosclerosis, interstitial fibrosis, and tubular atrophy. Types: Benign nephrosclerosis: gradual progression; associated with essential HTN. Malignant nephrosclerosis: due to severe/accelerated HTN → rapid renal failure and microangiopathic changes. Epidemiology: Common cause of CKD; more prevalent in African American patients due to APOL1 gene risk variants. 2. History Long-standing hypertension (often poorly controlled). Typically asymptomatic early; identified through elevated blood pressure and mild kidney dysfunction. Gradual development of symptoms of CKD: fatigue, nocturia, edema (later stages). Malignant hypertension history clues: headaches, vision changes, chest pain, neurologic symptoms. 3. Exam Findings Blood pressure: chronically elevated; may be severe in malignant nephrosclerosis. Signs of CKD progression: peripheral edema, crackles (fluid overload). Malignant HTN signs (if present): Retinal hemorrhages/exudates, papilledema. Neurologic deficits. Cardiovascular findings: LV hypertrophy or displaced PMI may be present due to chronic HTN. 4. Making the Diagnosis Labs: Mild proteinuria (usually