‘Hypertensive nephrosclerosis’ is moving up the charts to number 2 in terms of diagnostic frequency cited as causing end‐stage renal disease (ESRD) in chronic dialysis patients; the entity was recognized as early as 1873 . Type 2 diabetes mellitus holds first place and glomerulonephritis (all types) has fallen to third place in the ranking. Contact ONLINE DOCTOR to get more details quickly and directly for free.
The diagnostic criteria for type 2 diabetes and glomerulonephritis are relatively secure. Malignant hypertension with fibrinoid necrosis and relatively acute renal failure is a well understood pathological entity.
The diagnosis of hypertensive nephrosclerosis is dependent on the exclusion of other primary renal diseases. A careful past history, family history, search for signs for target organ damage, such as left ventricular hypertrophy and hypertensive retinal changes, careful urine microscopy, measurement of 24-h urinary protein and performance of renal ultrasound should establish the diagnosis, with additional tests for glomerulonephritic or vasculitic diseases if indicated. Such an approach was vindicated at about the 90% specificity level by the renal biopsy study performed on the pilot patients in the African-American Study on Kidney Disease and Hypertension (AASK) which is discussed further subsequently. As in the diagnosis of diabetic glomerulosclerosis, renal biopsy for the diagnosis of hypertensive nephrosclerosis is indicated in clinical practice only when there is substantial doubt based on the clinical evidence. In my view, biopsy should be considered in patients who do not have accelerated hypertension or a long history of hypertension, whose serum creatinine is less than 2.5–3 mg/dl and in whom 24-h urine protein excretion exceeds 1.5 g/24 h.
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