PATHOPHYSIOLOGY OF NEPHROSCLEROSIS

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Two pathophysiologic mechanisms have been proposed for the development of hypertensivenephrosclerosis.
One mechanism suggests that glomerular ischemia causes hypertensivenephrosclerosis. 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
becomesclerotic. As an attempt to compensate for the loss of renal function, the remaining nephronsundergo
vasodilation of the preglomerular arterioles and experience an increase in renal bloodflow and glomerular
filtration. The result is glomerular hypertension, glomerular hyperfiltration,and progressive glomerular sclerosis.
These mechanisms are not mutually exclusive, and theymay operate simultaneously in the
kidney. NEPHROSCLEROSIS
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Hardening of the walls of the small arteries and arterioles (smallarteries that convey blood from arteries to the
even smallercapillaries) of the kidney. This condition is caused by hypertension.Hypertension can be present in a
person for20 to 30 years without evidence of kidney involvement; suchpersons 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 benign or malignant.RENAL ANATOMY AND
PHYSIOLOGY
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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 thekidneys 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 oneas long as disease or other factors do not strain the organ.
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idney 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 thekidney into the bladder as urine. A loss of kidney
function results in the need for dialysis, whichis 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.
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Renal Anatomy: The kidneys are situated in the perinephric fat but are also surrounded by a toughfibrous layer of
connective tissue called the fibrous renal capsule. The hilus of the kidney is thecentral indent that gives the bean
shape to the organ, and it is where the artery carryingoxygenated blood enters, and the ureter carrying urine exits,
the kidney. Within the kidney, therenal artery branches into smaller blood vessels.