genitourinary disorders
Hypertensive Arteriolar Nephrosclerosis
Diagnosis of Hypertensive Arteriolar Nephrosclerosis
History of hypertension Blood tests indicating renal failure Signs of hypertensive end-organ damage No other cause of chronic kidney disease The diagnosis may be suspected when routine blood tests indicate deteriorating renal function (eg, elevated creatinine and bloodureanitrogen, hyperphosphatemia) in a hypertensive patient. Diagnosis is usually inferred because of the history and evidence of hypertension-related end-organ damage (eg, retinal changes, left ventricular hypertrophy) on physical examination. Hypertension should be present before onset of proteinuria and renal failure, and there should be no other clinically suspected cause of renal failure. Urine testing should not suggest other causes of renal failure (eg, glomerulonephritis, hypertensive emergency). On urinalysis, there should be few cells or casts in the sediment, and protein excretion is usually<1 g/day (it is occasionally higher and in the nephrotic range). Ultrasonography should be done to exclude other causes of renal failure. It may show that kidney size is reduced. Renal biopsy is done only if the diagnosis remains unclear. 