Nephrosclerosis - Specialists and Information

Chronic high blood pressure (hypertension) can lead to a whole range of serious complications. These include nephrosclerosis. Nephrosclerosis is a kidney disease that can be benign or malignant. As a result, the course of the disease can vary greatly. However, treatment is the same for both: the goal is to lower blood pressure and prevent further damage to the kidney tissue.

Below you will find additional information as well as a list of selected nephrosclerosis specialists.

Types of Nephrosclerosis

A basic distinction is made between:

• Benign
• Malignant nephrosclerosis

In benign nephrosclerosis, there is a slow but continuous progression of damage to the kidney tissue. At the same time, uncontrolled connective tissue is produced, which in turn leads to tissue hardening (sclerosis) in the kidney. Another associated symptom is hyalinosis (the deposition of transparent substances). The course of benign nephrosclerosis can extend over a period of several years.

In contrast, the course of malignant nephrosclerosis is shorter and more severe: there is a sudden deterioration in kidney function, and blood pressure rises sharply. Experts also refer to this course as a hypertensive crisis.

There are three stages of the disease:

1. Microalbuminuria: Excretion of elevated amounts of the protein albumin in the urine. (30–300 mg/day)
2. Benign hypertensive nephrosclerosis: Excretion is > 300 mg/day
3. Arterio-arteriolosclerotic: Shrunken kidney with renal insufficiency

Furthermore, experts distinguish between nephrosclerosis with and without renal insufficiency.

Albuminuria (protein) is the leading symptom of kidney disease @ Saiful52 /AdobeStock

Typical symptoms of nephrosclerosis

In both benign and malignant nephrosclerosis, the initial symptoms are those of arterial hypertension (high blood pressure).

The symptoms are often quite nonspecific and include dizziness, visual disturbances, or a feeling of tightness in the chest.

In the benign form of nephrosclerosis, symptoms of kidney failure develop gradually, whereas in the malignant form, they appear acutely.

These include:

• Decreased urine output
• Fluid accumulation in the lungs (pulmonary edema)
• Muscle weakness
• Heart rhythm disturbances
• Complete loss of kidney function

Risk factors for nephrosclerosis

The likelihood of developing nephrosclerosis depends on several factors:

• For example, people of Sub-Saharan African descent are about four times more likely to develop the condition than people of European descent.
• Other at-risk groups include men, people over 50, smokers, and people with low socioeconomic status—that is, those with, among other things, a lower level of education.
• Pre-existing conditions, such as a lipid metabolism disorder or a reduced number of nephrons, also play a major role.
• In addition, there may also be a genetic predisposition to nephrosclerosis.

Diagnosis of Nephrosclerosis

• In the case of benign nephrosclerosis, the diagnosis is often initially a presumptive one that arises during a routine blood test.
• If the doctor detects kidney damage, a urine test is performed. An elevated protein concentration is typical.
• Equally important are comprehensive physical examinations and a detailed medical history (review of the patient’s medical history). During the medical history, the patient describes the existing symptoms in detail, and the doctor identifies specific risk factors.
• Only a tissue biopsy can provide absolute certainty regarding the presence of nephrosclerosis. However, a kidney biopsy carries numerous complications, which is why experts often opt not to perform it in clinical practice. Treatment aimed primarily at restoring and maintaining kidney function is possible even without a biopsy.

Nephrosclerosis: Prognosis and Treatment

In the benign form, the prognosis depends heavily on whether irreparable damage to the kidneys has already occurred. Therefore, early diagnosis and treatment are of great importance.

In the malignant form of the disease, which is less common, the focus is on normalizing blood pressure. This allows experts to prevent permanent damage and kidney failure.

Lowering high blood pressure—the trigger for kidney disease—is central to any treatment. To this end, antihypertensive medications—ACE inhibitors or, alternatively, AT1 antagonists—are used.

Nephrosclerosis always occurs in conjunction with high blood pressure @ stivog /AdobeStock

The extent to which blood pressure is lowered depends on protein excretion: if protein excretion is elevated, the target is <130/80 mmHg; otherwise, it is 140/90 mmHg.

In addition to taking medication and strictly and regularly monitoring blood pressure, a healthy lifestyle is of great importance. 

Physical activity and weight loss can also have a positive effect on overall health. 

There are other measures you can take to lower your blood pressure:

• Stress reduction (such as through relaxation exercises)
• Limiting salt intake in your diet 
• Avoiding alcoholic beverages
• A healthy diet is very important to allow kidney tissue to regenerate. Beneficial nutrients include omega-3 fatty acids, amino acids, antioxidants, and foods that naturally help lower cholesterol.