PATHOPHYSIOLOGY OF NEPHROSCLEROSIS

Two pathophysiologic mechanisms have been proposed for the development of hypertensive
nephrosclerosis. One mechanism suggests that glomerular ischemia causes hypertensive
nephrosclerosis. This occurs as a consequence of chronic hypertension resulting in narrowing of
preglomerular arteries and arterioles, with a consequent reduction in glomerular blood flow.
Alternatively, glomerulosclerosis occurs because of glomerular hypertension and glomerular
hyperfiltration. According to this theory, hypertension causes some glomeruli to become sclerotic.
As an attempt to compensate for the loss of renal function, the remaining nephrons undergo
vasodilation of the preglomerular arterioles and experience an increase in renal blood flow and
glomerular filtration. The result is glomerular hypertension, glomerular hyperfiltration, and
progressive glomerular sclerosis. These mechanisms are not mutually exclusive, and they may
operate simultaneously in the kidney.

NEPHROSCLEROSIS

Hardening of the walls of the small arteries and arterioles (smallarteries that convey blood from a
rteries to the even smallercapillaries) of the kidney. This condition is caused by hypertension.Hyp
ertension can be present in a person for20 to 30 years without evidence of kidney involvement; su
chpersons usually die of other effects of hypertension such ascongestion of blood in the heart, har
dening of the heart tissue, orcerebral (brain) hemorrhage. If these maladies do not occur first,
there is usually some eventual renal (kidney) involvement.Nephrosclerosis is classified as either b
enign or malignant.

RENAL ANATOMY AND PHYSIOLOGY

The kidneys are bean-shaped organs that sit in the back of the lower abdominal cavity on either
side of the spinal cord. The organs are cushioned by perinephric fat, fatty tissue that surrounds the
kidneys and adrenal glands to prevent damage and movement in the abdominal cavity. Under
normal conditions, humans are born with two kidneys, but it is possible to survive with only one
as long as disease or other factors do not strain the organ.
Kidney Function: The main function of the kidney is to maintain the fluid, electrolyte, and pH
balance of the body by filtering ions, macromolecules, water, and nitrogenous wastes from the
blood based on the bodys condition. Wastes filtered out of the blood drains from canals in the
kidney into the bladder as urine. A loss of kidney function results in the need for dialysis, which
is an artificial method of removing wastes from the blood by running the blood from the body,
through an artificial kidney, and then back into the body.
Renal Anatomy: The kidneys are situated in the perinephric fat but are also surrounded by a tough
fibrous layer of connective tissue called the fibrous renal capsule. The hilus of the kidney is the
central indent that gives the bean shape to the organ, and it is where the artery carrying
oxygenated blood enters, and the ureter carrying urine exits, the kidney. Within the kidney, the
renal artery branches into smaller blood vessels.