Nephrosclerosis
What is it?
Nephrosclerosis is a kidney disorder in which the
smallest arteries in the kidneys, called the arterioles,
are damaged. This type of damage is referred to as
arteriosclerosis of the kidney arteries. Nephrosclerosis
can be benign, which means it occurs over a period of
years and rarely leads to kidney failure on its own.
Malignant nephrosclerosis, however, progresses very
quickly and the damaged arteries are unable to provide
enough oxygen to the kidney tissues, resulting in kidney
failure. Sclerosis means thickening or scarring.
Who gets it?
Benign nephrosclerosis often occurs in the elderly.
People with severe high blood pressure (malignant
hypertension) are more likely to develop malignant
nephrosclerosis. Malignant nephrosclerosis is more common
in African Americans than Caucasians. Men are more likely
to develop this condition between the ages of 40 and 50,
while women are more likely to be affected in their 30s.
What causes it?
Benign nephrosclerosis may naturally occur with age as
a result of years of mild high blood pressure (chronic
hypertension). Malignant nephrosclerosis is caused by
severe high blood pressure that is not controlled. It can
also be caused by conditions such as chronic kidney
failure, glomerulonephritis, renal vasculitis, and renal
vascular hypertension.
What are the symptoms?
Benign nephrosclerosis progresses slowly, so symptoms
may not be noticed unless the condition progresses to
malignant nephrosclerosis. Symptoms of malignant
nephrosclerosis occur when severe high blood pressure
causes injury to the kidneys, heart, and brain. Symptoms
can include blurred vision, headache, confusion, lethargy,
nausea, vomiting, and heart failure. Seizures and coma may
also occur.
How is it diagnosed?
To diagnose nephrosclerosis, your doctor will take a
complete medical history and perform a thorough physical
examination. Patients with benign nephrosclerosis may show
signs of decreased kidney function and have elevated
protein levels in the urine. Malignant nephrosclerosis is
indicated by severe high blood pressure, kidney failure,
and visual disturbances. Your doctor will examine the back
of your eye with an instrument called an ophthalmoscope.
Patients with malignant nephrosclerosis will have signs of
damaged blood vessels in the back of the eye, including
bleeding, swelling, and a build-up of fluid. The heart may
also be enlarged. Urine tests will show high levels of
protein and clumps of red blood cells. Blood tests will
show high levels of a protein called renin, which is
produced by the kidneys to help control blood pressure.
Your doctor may order a computed tomography (CT) scan to
rule out other disorders that can cause similar symptoms.
Malignant nephrosclerosis is considered a medical
emergency and requires immediate treatment to prevent
death and preserve kidney function.
What is the treatment?
Benign nephrosclerosis can be controlled by monitoring
blood pressure and taking medication to keep blood
pressure within normal ranges. Malignant nephrosclerosis
is treated by taking immediate measures to lower blood
pressure and by treating kidney failure. In some cases,
kidney dialysis, in which a machine filters waste products
from the blood for the kidneys, may be needed on a
temporary basis until the kidneys improve. However, some
patients require dialysis on a lifelong basis. Untreated,
malignant nephrosclerosis causes death in most patients
within one year.
Self-care tips
If you have high blood pressure, follow your doctor’s
recommendations for medications and lifestyle changes to
maintain your blood pressure within normal ranges.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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