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Diagnosing Vascular Causes of Renal Failure
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IN RESPONSE:
Dr. Ahrens reports that he has frequently seen patients with generalized atherosclerosis and progressive renal failure whose renal biopsy results show hypertensive nephrosclerosis despite mild or no hypertension. We have also seen such patients, but other cases may be unrecognized because the patients present with gradually worsening azotemia, for which renal biopsy is usually not done. The rapid progression to end-stage renal failure reported by Dr. Ahrens is somewhat surprising but could be explained by a second process, such as cholesterol emboli or renal artery stenosis.
Hypertensive or benign arteriolar nephrosclerosis is characterized by hyaline thickening of the glomerular arterioles. The small arteries show intimal thickening. A variable number of glomerular tufts appear retracted and ischemic, whereas a portion of the tubules may be either atrophic or dilated. Hypertensive nephrosclerosis without hypertension was recognized by pathologists many years ago during autopsies of persons without clinical renal disease [1]. The cause is unknown, but age and atherosclerosis appear to be factors in the pathogenesis [1, 2]. I have seen no reports associating this histologic picture with chronic renal failure.
J. Gary Abuelo, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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