Lesão renal na hipertensão essencial

Abstract

In the last decade the incidence of end-stage renal disease attributed to hypertensive nephosclerosis has increased significantly. This seems to be paradoxical, since effective pharmacological control of blood pressure in the last decade has led to a decrease in the prevalence of malignant hypertension as well as the cardiovascular morbidity related to hypertension. Current evidence favors the view that hypertension is an independent risk factor for the development of end-stage renal disease. The mechanisms by which hypertension damages the kidney remain incompletely defined. The two mechanisms currently postulated for the development of end-stage renal disease in the presence of hypertension are: 1) ischemia due to injury of the preglomerular vasculature; and 2) glomerular injury due to transmission of systemic hypertension to glomerular capilaries. In practice the diagnosis of hypertensive nephosclerosis is difficult, and it is made by ruling out others causes of renal failure clinically. The hypertensive nephosclerosis as well as primary renal disease, renal atherosclerotic disease and cholesterol microembolization can present with the same clinical picture. Due to this fact, the prevalence of hypertensive nephosclerosis might be overestimated. Despite of the fact that hypertensive nephosclerosis is overdiagnosed, there is a substantial fraction of hypertensive patients, which will suffer from “true hypertensive nephosclerosis”, and this number may increase as survival of hypertensive patients improves.