REPLY
Diagnosing Vascular Causes of Renal Failure
J. Gary Abuelo, MD
15 July 1996 | Volume 125 Issue 2 | Page 155
IN RESPONSE:
Dr. Ahrens reports that he has frequently seen patients with generalized atherosclerosis and progressive renal failure whose renal biopsy results show hypertensive nephrosclerosis despite mild or no hypertension. We have also seen such patients, but other cases may be unrecognized because the patients present with gradually worsening azotemia, for which renal biopsy is usually not done. The rapid progression to end-stage renal failure reported by Dr. Ahrens is somewhat surprising but could be explained by a second process, such as cholesterol emboli or renal artery stenosis.
Hypertensive or benign arteriolar nephrosclerosis is characterized by hyaline thickening of the glomerular arterioles. The small arteries show intimal thickening. A variable number of glomerular tufts appear retracted and ischemic, whereas a portion of the tubules may be either atrophic or dilated. Hypertensive nephrosclerosis without hypertension was recognized by pathologists many years ago during autopsies of persons without clinical renal disease [1]. The cause is unknown, but age and atherosclerosis appear to be factors in the pathogenesis [1, 2]. I have seen no reports associating this histologic picture with chronic renal failure.
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Author and Article Information
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Rhode Island Hospital, Providence, RI 02903
1. Heptinstall RH. Hypertension. I: Essential hypertension. In: Heptinstall RH, ed. Pathology of the Kidney. 4th ed. Boston: Little, Brown; 1992:951-1028.
2. Kasiske BL. Relationship between vascular disease and age-associated changes in the human kidney. Kidney Int. 1987; 31:1153-9.
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