Journal of Clinical & Experimental Nephrology

Description

The kidneys becoming hard are the literal definition of nephrosclerosis. It is the consequence of scarring or substitution of the typical renal parenchyma by thick collagenous tissue. Nephrosclerosis refers, in practice, to conditions in which the glomeruli and interstitium are primarily affected by pathologic changes in the preglomerular microvasculature. Surprisingly, patients with persistent mild to moderate hypertension rarely experience an increase in serum creatinine levels. Patients with hypertensive ESRD typically present with advanced disease, making it difficult to identify the processes that started the renal disease. When presented with identical clinical histories, nephrologists are twice as likely to diagnose hypertensive nephrosclerosis in an African-American patient as they are in a white patient. According to the findings of this review, it is possible that the majority of patients who are given the diagnosis of hypertensive nephrosclerosis actually have primary renal microvascular disease, stenosis of the renal arteries, or unrecognized episodes of accelerated hypertension. The identification of genes associated with renal injury in animals and the familial clustering of ESRD attributed to hypertension in African-Americans support the idea that inherited factors may predispose to renal failure.

Angiotensin Converting Enzyme

Members of African-American families frequently have ESRD from a variety of causes, including hypertensive ESRD. This suggests that progressive renal failure in various forms of nephropathy is caused by the same mechanisms, whether they are inherited or environmental. The idea that mild to moderate elevations in blood pressure they are uncommon causes of nephrosclerosis would be supported by the identification of the mechanisms that produce susceptibility to progressive renal disease. In hypertensive nephrosclerosis, ACE inhibition is effective and protects the kidneys from damage: The AASK trial, or African American Study of Kidney Disease and Hypertension. In patients with mild-to-moderate renal insufficiency, an interim analysis of the AASK trial at three years shows that the Angiotensin Converting Enzyme (ACE) inhibitor ramipril has a renoprotective effect delayed onset of significant decrease in GFR, end-stage renal disease or death, and a decrease in urinary protein excretion over the dihydropyr Patients with proteinuric  and non-proteinuric hypertensive nephrosclerosis saw the beneficial effect in the presence of similar levels of blood pressure control.

The effectiveness of the beta-blocker metoprolol and the ACE inhibitor was not significantly different at the time of the interim analysis. DHP-CCBs should be used with caution in patients with mild to moderate renal impairment, according to the data. Hypertension and atheromatous renal disease are frequently linked to the development of progressive renal disease in elderly patients with essential hypertension, sometimes regardless of blood pressure control. Through chronic micro-embolization into the kidney or renal artery stenosis, this disease may result in renal failure. Renal vascular changes that are qualitatively indistinguishable from those that are associated with aging are consistently associated with non-severe uncomplicated essential hypertension.

Atheromatous Renal Disease

Despite the genuinely steady presence of supposed harmless hypertensive nephrosclerosis in patients with laid out hypertension, just a subset of these patients show moderate renal harm. There may be three progression mechanisms at work: in some susceptible individuals, a combination of ischemic and hypertensive glomerular mechanisms; non-hemodynamic factors like the mechanisms of the local immune system; or, three, the presence of metabolic abnormalities that contribute to glomerulosclerosis. It has been demonstrated that parenteral administration of Compound lowers systolic blood pressure in both normotensive dogs and spontaneously hypertensive rats. Compound has been found to have cholinomimetic effects in animal tissue preparations and live animals in subsequent research. According to our research, men with SHR who took Compound on a daily basis were less likely to develop hypertensive nephrosclerosis and died earlier. In isolated rabbit hearts, compound enhanced cholinergic activity as well. Compound may be responsible for the hypotensive effect and the prevention of nephrosclerosis in SHR through cholinergic vasodilation. In benign nephrosclerosis, the onset of glomerular sclerosis was investigated. Immunohistochemistry and in situ hybridization were used to examine the expression of type III and IV collagens and their mRNAs within the glomeruli. The intensity of type IV collagen staining in the glomerulus of BNS patients increased during the sclerotic process. At the beginning of the sclerotic process, the glomerulus showed the most staining, with a slight decrease in intensity as the disease progressed. In spite of the fact that type III collagen was missing in typical and nonsclerotic glomeruli, fringe locales of the sclerotic glomeruli were positive at the early sclerotic stage. Afterward, type III collagen was diffusely seen in the totally hyalinized glomeruli.

Using thymine-thymine dimerized synthetic oligonucleotides, the non-radioactive in situ hybridization technique was used to detect the expression of type III and type IV collagen mRNAs in the glomeruli of BNS. At the pre-sclerotic and early sclerotic stages, the number of cells with type III and type IV collagen mRNA positivity increased. However, as glomerular sclerosis progressed, the number of these cells gradually decreased. Two cases of malignant nephrosclerosis during pregnancy are described with their histologic, immune-histologic, and ultra-structural features. Mid-trimester and postpartum toxemia of pregnancy can be distinguished from primary malignant nephrosclerosis, a clinical entity. The morphology is distinct from that of toxemia, despite the fact that disseminated intravascular coagulation appears to be involved. The hemolytic uremic syndrome is very similar to malignant nephrosclerosis. A lethal outcome caused by progressive renal failure may be avoided with prompt diagnosis and appropriate treatment through renal biopsy. One-third of patients with IgAN are the most common type of primary glomerulonephritis worldwide. Percutaneous kidney biopsy is currently used to diagnose IgAN.