Nephrosclerosis - Urinary Tract Disorders

NEPHROSCLEROSIS

Nephrosclerosis is hardening, or sclerosis, of the arteries of thekidney due to prolonged hypertension. This causes decreased blood flow to the kidney and patchy necrosis of the renal paren-chyma. Eventually, fibrosis occurs and glomeruli are destroyed. Nephrosclerosis is a major cause of ESRD (Segura, Campo, Rodicio & Ruilope, 2001).

Pathophysiology

There are two forms of nephrosclerosis: malignant (accelerated) and benign. Malignant nephrosclerosis is often associated with malignant hypertension (diastolic blood pressure higher than 130 mm Hg). It usually occurs in young adults, and men are af-fected twice as often as women. The disease process progresses rapidly. Without dialysis, more than half of patients die from ure-mia in a few years. Benign nephrosclerosis is usually found in older adults and is often associated with atherosclerosis and hypertension.

Assessment and Diagnostic Findings

Symptoms are rare early in the disease, even though the urine usually contains protein and occasional casts. Renal insufficiency and associated signs and symptoms occur late in the disease.

Medical Management

Treatment of nephrosclerosis is aggressive antihypertensive ther-apy. In hypertensive nephrosclerosis, therapy containing an ACE inhibitor, alone or in combination with other antihypertensive medications, significantly reduces the incidence of renal events. This effect is independent of blood pressure control (Segura et al., 2001).