Systemic and glomerular hypertension and progression of chronic renal disease: The dilemma of nephrosclerosis

Abstract

The link between the kidney and hypertension has been considered a villain-victim relationship. High blood pressure levels are a well-recognized feature in chronic renal disease, but the ability of mild-to-moderate hypertension to produce renal insufficiency has been questioned. Nephrosclerosis, benign nephrosclerosis, and hypertensive kidney disease are terms that clinicians use when renal damage is thought to be secondary to essential hypertension. Many cases of end-stage renal disease are ascribed to so-called benign nephrosclerosis. This entity could actually be a primary renal disease affecting the preglomerular microvasculature, perhaps genetically mediated and ethnically influenced, and showing a heterogeneous clinical expression. African Americans suffer from nephrosclerosis more frequently than Caucasians. Nephrosclerosis affecting Caucasians seems to show a less aggressive pattern and could represent early age-related renal sclerosis. The risk of end-stage renal disease is increased when atherosclerotic lesions in large renal arteries coexist. Age, systolic blood pressure, proteinuria, and concomitant cardiovascular disease are well-known promoters of renal failure. A multifactorial strategy, including antihypertensive and antiproteinuric drugs, and lipid-lowering and anti-platelet agents, could improve cardiovascular and renal outcomes in patients with nephrosclerosis.

Renal Protective Effect in Hypertensive Patients: The High Doses of Angiotensin II Receptor Blocker (HARB) Study

“…Proteinuria is one of the clinical parameters for diagnosing renal damage, especially glomerular hypertension, and is a risk factor and predictor for cardiovascular events (3). Reducing glomerular pressure is a principal strategy for reducing proteinuria in hypertensive patients (4). To decrease glomerular pressure, blood pressure (BP) must be lowered, and arteriolar resistance in efferent arterioles must be reduced (5,6).…”

Comparison of the antiproteinuric effects of the calcium channel blockers benidipine and amlodipine administered in combination with angiotensin receptor blockers to hypertensive patients with stage 3–5 chronic kidney disease

“…1 Proteinuria is one of the clinical parameters for diagnosing renal damage, particularly in glomerular hypertension, and it has been reported to be a risk factor and predictor of cardiovascular events. 2,3 Therefore, suppression of proteinuria is a major goal in the treatment of hypertensive patients with CKD. The renoprotective effects of angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) have been shown earlier.…”

Preditores de insuficiência renal crônica em pacientes de centro de referência em hipertensão arterial

“…Dois fatores de risco para o desenvolvimento de insuficiência renal (presença de doença cardiovascular prévia e tempo de duração da hipertensão arterial) 27 não foram avaliados no presente trabalho, entretanto, mesmo que estes se associem com o prognóstico renal, isto não anula o fato de que pacientes com proteinúria avançaram mais frequentemente para insuficiência renal e, portanto não impede a validação da proteinúria à urina I como marcador prognóstico.…”