nephrosclerosis

Nephrosclerosis refers to sclerosis and scarring of the kidney tissue due to chronic ischemic injury, most often from long-standing hypertension or diabetes. It is a common cause of chronic kidney disease in adults and can contribute to progressive loss of kidney function.

Causes and forms commonly include hypertensive nephrosclerosis, related to long-standing high blood pressure; malignant or accelerated nephrosclerosis, associated with severely elevated blood pressure and acute vascular injury; and diabetic nephrosclerosis, tied to diabetic microangiopathy. Aging and other vascular risk factors can also play a role. The condition may be part of a broader spectrum of hypertensive and diabetic kidney disease.

Pathology typically involves small arteries and arterioles with hyaline arteriolosclerosis, leading to reduced renal perfusion and ischemic injury. Glomerulosclerosis and tubulointerstitial fibrosis are common, and kidneys may become small and granular at autopsy or on imaging. In malignant hypertension, the arterioles can show onion-skin hyperplasia and fibrinoid necrosis of vessel walls.

Clinical features are often subtle; nephrosclerosis may be discovered incidentally or present with signs of chronic kidney disease, such as gradually increasing creatinine and proteinuria, along with long-standing hypertension. Edema and overt uremia appear in advanced stages.

Diagnosis relies on clinical context, laboratory findings, and sometimes imaging. Kidney biopsy is not routinely required but may be performed to clarify the extent of vascular and parenchymal injury in selected cases.

Treatment centers on controlling blood pressure and managing underlying conditions. Renal protection includes ACE inhibitors or ARBs, strict glycemic control in diabetes, and lifestyle measures. Progression to end-stage kidney disease may require renal replacement therapy.