Nephrosclerosis Causes Symptoms and Treatment

 

What is Nephrosclerosis and what are the causes of Nephrosclerosis?

Nephrosclerosis (hypertensive nephrosclerosis, hypertensive nephropathy, or hypertensive kidney disease, مرض تصلّب شرايين الكلى) is a progressive renal disease caused by chronic intrarenal hypertension, prolonged standing, or diabetes, and is commonly associated with arteriosclerosis. It often presents as an Acute hypertensive episode with a severe spike in blood pressure (above 140 mm Hg) that develops suddenly and rapidly and causes some type of organ failure. An ideal blood pressure is considered to be around 80-100 mm Hg for women, and 100-120 for men.

Renal sclerosis or hardening of the walls of the capillaries and arterioles often leads to thickened and narrowed capillary lumens, which reduces blood flow. If left untreated, it can lead to hypertrophy and hyperplasia of the juxtaglomerular apparatus of the kidneys and can lead to kidney failure and heart failure, as it affects mainly the nephrons.[1]

It affects about 1% of people with uncontrolled and prolonged hypertension (a normal value is 120/80 mm Hg or lower), the disease group affects both children and adults; however, it is more common in young adults. Moreover, nephrosclerosis is very common  in hypertensive pregnant women, and in people with chronic kidney disease (CKD).

People with renovascular hypertension or chronic kidney disease have an increased risk of developing kidney failure through the effects of renal artery stenosis and nephrosclerosis.

What blood pressure reading is an emergency?

A hypertensive crisis is a severe increase in blood pressure that develops suddenly. Without prompt treatment, it and can damage blood vessels and can lead to a stroke. Extremely high blood pressure is considered to be around 180/120 mm Hg or higher.

Alternative names of nephrosclerosis
Arteriolar nephrosclerosis, accelerated hypertension, malignant hypertension and arteriolar hypertension.

Symptoms

What are the symptoms of Nephrosclerosis?

Nephrosclerosis is progressive kidney disease caused by hypertension, prolonged standing, or diabetes. The person may develop symptoms such as:

1. Hot spot or flushing, it is a corposcular response to an emotional trigger that results in vasodilation of arteries and vessels to increase cellular perfusion, which often results in a flush, accompanied with a visible hyperemia of the skin commonly affecting the face, neck, ears, and upper chest.
2. Blurred vision
3. An alteration in mental status presenting with a combination of euphoria and dementia.
4. Decreased alertness and low concentration.
5. Sleepiness
6. Confusion
7. Restlessness, which is one of the most common manifestations of anxiety
8. Anxiety
9. Midsternal chest pain
10. Headache
11. Dyspnea and shortness of breath
12. Decreased urine output
13. Coughing
14. Numbness or weakness in the extremities, or face
15. Nausea or vomiting

Treatment

How to treat hypertensive nephrosclerosis?

Hypertensive nephrosclerosis is an emergency that requires intensive inpatient care for at least two weeks, patients should remain hospitalized until the blood pressure is normalized.

The following therapy is usually the first choice to reduce common symptoms of pneumonia and to treat hydrothorax:

Antibiotics, such as benzylpenicillin (INN, AAN, BAN, USAN), cephalosporins (Ceftriaxone‎, Cephalexin‎), or macrolides (erythromycin, azithromycin), are used to treat infections.

Thoracoscopy is used for the diagnosis and management of  hydrothorax, a video-assisted thoracoscopic surgery (VATS) is performed to treat transudative pleural effusion in patients with chronic hepatic disease.

Therapeutic thoracentesis (pleural tap, thoracostomy) is a procedure performed when chest X-ray shows massive pleural effusion to drain excess pleural fluid from the chest through a tunneled pleural catheter, which is inserted through the chest, especially when the patient complains of difficulty breathing.

Pulmonary edema is a common manifestation of heart failure. [1]

Malignant hypertension (arteriolar nephrosclerosis) often leads to myocardial hypertrophy, which can cause cardiac damage or myocardial infarction if left untreated for a sufficient period of time; however, a proper medicinal therapy may prevent the worsening of Nephrosclerosis, and can reduce the risk of stroke by reducing blood pressure.

Hypertensive emergency guidelines

How to manage hypertensive emergency and how do you treat a hypertensive crisis?

A spike in blood pressure could lead to hypertensive urgency, which must be reduced immediately to prevent permanent organ damage. Lower blood pressure gradually at a rate of 20-25% / 1-1.5 hr until level is below 160/100 mm Hg.

What drug do you give for hypertensive crisis?

BP should be slowly lowered over a period of minutes to hours by administering nitroprusside sodium 0.5-10 μg/kg/min IV infusion (an antihypertensive agent). Blood pressure must be monitored every 5-10 minutes until level is between 140/80 and 160/100 mm Hg, as an acute hypertensive episode (AHE) can lead to a stroke.

Antihypertensive drugs must be adjusted hourly, because it’s difficult to control Malignant hypertensive crisis.

Clonidine or Captopril (oral tablets) are hypotensive agents commonly used to treat high blood pressure, and anxiety, etc. the hypotensive actions of clonidine are characterized by a longer lasting decrease in heart rate and blood pressure.

High blood pressure can often be prevented or reduced by proper lifestyle modifications (eating healthy foods, being fit, regular exercising, drinking alcohol in moderation and not smoking).[18]

Chronic stress often causes hypertension; However, exercising five times a week for 15-30 minutes can reduce stress.

Persistent pressure can be controlled by one of the following procedures:

1. Surgical nephrectomy
2. Laparoscopic nephrectomy
3. Renal artery embolization

Prevention

How to prevent nephrosclerosis?

The best way to prevent nephrosclerosis is to eat a healthy diet (DASH diet, or Diet number 7), and exercise regularly, as a balanced heart-healthy diet can reduce your risk of heart disease and diabetes by 80%, as well as it will prevent kidney damage from high blood pressure, which will protect you from getting nephrosclerosis. [1]

The DASH diet is composed basically of whole grains, fish, poultry, fruits, vegetables, and nuts; However, it contains limited amounts of red meat, sugar, fat dairy products, etc. to provide sufficient quantities of calcium, potassium, and magnesium for the body to function properly. The DASH diet is more effective at lowering blood pressure than sodium restriction alone.

If you have concerns about nephrosclerosis, please feel free to contact us.

 

 

 

 

References

 

Nephrosclerosis

Verified by: Dr.Diab (July 1, 2018)

Citation: Dr.Diab. (July 1, 2018). What is Nephrosclerosis? Causes Symptoms and Treatment. Medcoi Journal of Medicine, 31(2). urn:medcoi:article1923.