Systemic arterial hypertension has been classified according to etiology in essential, primary or idiopathic and secondary. It has also been classified as mild, moderate and severe according to values of systolic and diastolic pressure. Sometimes the term benign hypertension is used to call the mild to moderate hypertension. Malignant hypertension is defined by rapid damage of one or several target organs rather than an exact number of blood pressure. Initially we will refer to renal changes in chronic hypertension and in a different section, in this page, we will refer to renal changes in malignant hypertension. The renal involvement in HBP is also known as hypertensive nephropathy.

HBP is a risk factor for chronic kidney disease and other organs damage, however, is usually asymptomatic until advanced stages of tissue lesion. The physiopathology of hypertension is complex and widely discussed in other texts. Here we shall only present renal alterations secondary to it.

When the disease has produced significant renal injury, the organ is reduced in size and weight, there is usually a granular capsular surface and depressions may be secondary to fibrosis by ischemia: scars; these changes are very characteristic of hypertensive nephropathy. The cortex is thin and often there are simple cysts with variable size.

Histopathology

The renal histological changes of chronic hypertension are not specific. Glomerular and tubulointerstitial lesions are of ischemic type and its microscopic appearance is similar in all forms of vascular injury with secondary ischemic renal damage. The glomeruli are retracted, capillary walls are thick and wrinkled with rolling or “accordion-shape” and there is a relative increase in the Bowman’s space. Changes in the capillary walls become more evident with PAS or silver staining. In some cases focal and segmental sclerosing lesions can be evidenced and they can be associated with proteinuria In more advanced stages collagen deposits are evidenced in the inner portion of the Bowman’s capsule Initially, collagen is deposited near to the vascular pole and gradually fills the entire circumference of the Bowman’s space, the tuft is compressed by the fibrous tissue and the glomerulus ends in ischemic type global sclerosis In cases of global glomerular sclerosis the fibrous tissue and the sclerosed tuft stain with a similar appearance with H&E, but with PAS and methenamine-silver there is a evident contrast between the scarring collagen that occupies the Bowman’s space which is weakly positive or negative with both stains, and the type of collagen in the compressed glomerular tuft: sclerosis, which is intensively positive with PAS or silver.

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