Nephrosclerosis Clinical Presentation

Updated: Dec 06, 2018
  • Author: Fernando C Fervenza, MD, PhD; Chief Editor: Vecihi Batuman, MD, FASN  more...
  • Print


Patients may present with hypertension, its complications (eg, heart failure, stroke), and/or symptoms of uremia. In most patients, hypertension is present for many years (usually >10 y), with evidence of periods of accelerated or poorly controlled BP.

Features suggesting the diagnosis of hypertensive nephrosclerosis are as follows:

  • Black race

  • Hypertensive retinal changes

  • Left ventricular hypertrophy

  • Long-standing or very severe hypertension

  • Proteinuria less than 0.5 g/d

  • Hypertension diagnosed prior to the onset of proteinuria

  • Hypertension preceding renal dysfunction

  • No evidence of another renal disease

  • Biopsy findings compatible with the diagnosis



Upon physical examination, evidence of hypertension-related target organ damage includes hypertensive changes in the retinal vessels and signs of left ventricular hypertrophy.

Hemorrhages or exudates are characteristic of accelerated hypertension, and papilledema is a feature of malignant hypertension.



No specific causes for hypertensive nephrosclerosis are known.

A gene that predisposes to hypertensive renal injury has been identified in rats. To date, however, no specific hypertensive ESRD-associated gene has been identified in humans. It must be noted that the APOL1 gene variant can increase the risk of renal disease progression in African American hypertensive patients, but the mechanism by which it causes progression of renal disease is unknown and it is unclear whether the gene variant causes hypertension other than by causing renal disease first.

Correct identification of hypertensive nephrosclerosis susceptibility genes requires accurate hypertensive nephrosclerosis phenotyping. The major impediment to establishing a reliable hypertensive nephrosclerosis phenotype is the absence of strong clinical criteria to distinguish hypertensive nephrosclerosis from other renal diseases. Genetic approaches to hypertensive nephrosclerosis require careful scrutiny of clinical diagnoses before assigning phenotypes to study subjects.

See also Pathophysiology.