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Benign nephrosclerosis refers to the renal changes most commonly occurring in association with long-standing
Benign nephrosclerosis refers to the renal changes most commonly occurring in association with long-standing hypertension
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
. It is termed benign because it rarely progresses to clinically significant chronic kidney disease
Chronic kidney disease (CKD) is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years. Initially generally no symptoms are seen, but later symptoms may include leg swelling, feeling tired, vo ...
or kidney failure
Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...
.
__TOC__Morphology
The kidneys appear symmetricallyatrophic
Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations (which can destroy the gene to build up the organ), poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply t ...
and there is a reduced nephron
The nephron is the minute or microscopic structural and functional unit of the kidney. It is composed of a renal corpuscle and a renal tubule. The renal corpuscle consists of a tuft of capillaries called a glomerulus and a cup-shaped structure ca ...
mass. The kidneys have a surface of diffuse, fine granularity that resembles grain leather. Microscopically, the basic anatomic change consists of hyaline thickening of the walls of the small arteries and arterioles (hyaline arteriolosclerosis
Arteriolosclerosis is a form of cardiovascular disease involving hardening and loss of elasticity of arterioles or small arteries and is most often associated with hypertension and diabetes mellitus.
Types include hyaline arteriolosclerosis and hyp ...
). Under a microscope, this appears as a homogeneous, pink hyaline
A hyaline substance is one with a glassy appearance. The word is derived from el, ὑάλινος, translit=hyálinos, lit=transparent, and el, ὕαλος, translit=hýalos, lit=crystal, glass, label=none.
Histopathology
Hyaline cartilage is ...
thickening at the expense of the vessel lumina
Lumina may refer to:
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* ''Lumina'', a literary journal published by Sarah Lawrence College
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, with loss of underlying cellular detail. The narrowing of the lumen restricts blood flow, resulting in ischemia
Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems wi ...
. All structures of the kidney can show ischemic atrophy although glomerular ischemic atrophy may be patchy. In advanced cases of benign nephrosclerosis the glomerular
''Glomerulus'' () is a common term used in anatomy to describe globular structures of entwined vessels, fibers, or neurons. ''Glomerulus'' is the diminutive of the Latin ''glomus'', meaning "ball of yarn".
''Glomerulus'' may refer to:
* the filte ...
tufts may become globally sclerosed. Diffuse tubular atrophy and interstitial fibrosis are present. Often there is a scant interstitial lymphocytic infiltrate. The larger blood vessels (interlobar and arcuate arteries) show reduplication of internal elastic lamina
The internal elastic lamina or internal elastic lamella is a layer of elastic tissue that forms the outermost part of the tunica intima of blood vessels. It separates tunica intima from tunica media.
Histology
It is readily visualized with light ...
along with fibrous thickening of the media (fibroelastic hyperplasia) and the subintima.
Clinical Course
Benign nephrosclerosis alone hardly ever causes severe damage to the kidney, except in susceptible populations, such as African Americans, where it may lead touremia
Uremia is the term for high levels of urea in the blood. Urea is one of the primary components of urine. It can be defined as an excess of amino acid and protein metabolism end products, such as urea and creatinine, in the blood that would be nor ...
and death. However, all persons with this disease usually show some functional impairment, such as loss of concentration or a variably diminished GFR GFR may refer to:
* Gas-cooled fast reactor
* Gefreiter
* General fertility rate
* Glomerular filtration rate
* Government Flight Representative
* Grand Forks Railway, a Canadian railway
* Grand Funk Railroad, an American rock band
* Grup Ferovi ...
. A mild degree of proteinuria
Proteinuria is the presence of excess proteins in the urine. In healthy persons, urine contains very little protein; an excess is suggestive of illness. Excess protein in the urine often causes the urine to become foamy (although this symptom ma ...
is a frequent finding.
See also
*Hypertensive kidney disease
Hypertensive kidney disease is a medical condition referring to damage to the kidney due to chronic high blood pressure. It manifests as hypertensive nephrosclerosis (sclerosis referring to the stiffening of renal components). It should be disting ...
References
{{reflist Kidney diseases Cardiovascular diseases