Benign Nephrosclerosis
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Benign nephrosclerosis refers to the renal changes most commonly occurring in association with long-standing
hypertension Hypertension, also known as high blood pressure, is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not cause symptoms i ...
. It is termed benign because it rarely progresses to clinically significant
chronic kidney disease Chronic kidney disease (CKD) is a type of long-term kidney disease, defined by the sustained presence of abnormal kidney function and/or abnormal kidney structure. To meet criteria for CKD, the abnormalities must be present for at least three mo ...
or
kidney failure Kidney failure, also known as renal failure or end-stage renal disease (ESRD), 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 fa ...
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Morphology

The kidneys appear symmetrically
atrophic 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 structu ...
mass. The
kidney In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organ (anatomy), organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and rig ...
s 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 h ...
). Under a microscope, this appears as a homogeneous, pink
hyaline A hyaline substance is one with a glassy appearance. The word is derived from , and . Histopathology Hyaline cartilage is named after its glassy appearance on fresh gross pathology. On light microscopy of H&E stained slides, the extracellula ...
thickening at the expense of the vessel
lumina Lumina may refer to: Arts, entertainment, and media * ''Lumina'', a literary journal published by Sarah Lawrence College * ''World of Lumina'' or ''Lumina'', a graphic novel by Emanuele Tenderini and Linda Cavallini * "Lumina", a song by Joan Os ...
, 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 ...
. 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'' (; : glomeruli) 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 ...
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 African Americans, also known as Black Americans and formerly also called Afro-Americans, are an American racial and ethnic group that consists of Americans who have total or partial ancestry from any of the Black racial groups of Africa ...
, where it may lead to
uremia Uremia is the condition of having high levels of urea in the blood. Urea is one of the primary components of urine. It can be defined as an excess in the blood of amino acid and protein metabolism end products, such as urea and creatinine, which ...
and death. However, all persons with this disease usually show some functional impairment, such as loss of concentration or a variably diminished GFR. A mild degree of
proteinuria Proteinuria is the presence of excess proteins in the urine. In healthy persons, urine contains very little protein, less than 150 mg/day; an excess is suggestive of illness. Excess protein in the urine often causes the urine to become fo ...
is a frequent finding.


See also

* Hypertensive kidney disease


References

{{reflist Kidney diseases Cardiovascular diseases