Dr. Roopam Jain, ADDITIONAL DEAN, Professor & Head, Dept. of Pathology & Blood Bank

1. The KIDNEY:
RENAL VASCULAR
DISEASES
DR. ROOPAM JAIN
PROFESSOR & HEAD, PATHOLOGY

2. RENAL
VASCULAR
DISEASES

3. RENAL VASCULAR DISEASES
• I. Most importantly, hypertensive vascular disease and its
consequent renal manifestations in the form of benign and
malignant nephrosclerosis.
• II. Th rombotic microangiopathy.
• III. Renal cortical necrosis.
• IV. Renal infarcts.

5. Etiologic classification of hypertension

6. The renin-
angiotensin
mechanism

7. EFFECTS OF HYPERTENSION
• Systemic hypertension causes major effects in three main organs—
heart and its blood vessels, nervous system, and kidneys.
• The renal effects
• benign nephrosclerosis
• malignant nephrosclerosis

8. Benign Nephrosclerosis
• the kidney of benign phase of hypertension.
• Mild benign nephrosclerosis is the most common form of renal disease in
persons over 60 years of age but its severity increases in the presence
of hypertension and diabetes mellitus

9. Small, contracted kidney in chronic hypertension (benign
nephrosclerosis).
The kidney is small and contracted. The capsule is adherent to the
cortex and has granular depressed scars on the surface.

10. Small, contracted kidney in chronic hypertension (benign
nephrosclerosis).
The kidney is small and contracted.
The capsule is adherent to the cortex & has granular
depressed scars on the surface.

11. A, Benign nephrosclerosis.
The vascular changes are hyaline arteriolosclerosis and intimal
thickening of small blood vessels in the glomerular tuft.
The parenchymal changes include sclerosed glomeruli, tubular
atrophy and fi ne interstitial fi brosis.

12. Benign Nephrosclerosis
CLINICAL FEATURES
• There is variable elevation of the blood pressure with headache,
dizziness, palpitation and nervousness.
• Eye ground changes may be found but papilloedema is absent.
• Renal function tests and urine examination are normal in early stage.
• In long-standing cases, there may be mild proteinuria with some hyaline
or granular casts.
• Rarely, renal failure and uraemia may occur.

13. Malignant Nephrosclerosis
• Malignant nephrosclerosis is the form of renal disease that occurs in
malignant or accelerated hypertension.
• Malignant nephrosclerosis is uncommon and usually occurs as a
superimposed complication in 5% cases of pre-existing benign essential
hypertension
• However, the pure form of disease also occurs, particularly at younger
age with preponderance in males

14. Malignant Nephrosclerosis

15. Malignant
Nephrosclerosis
The vascular changes are necrotising arteriolitis and hyperplastic
intimal sclerosis or onion-skin proliferation. The parenchymal changes
are tubular loss, fi ne interstitial fi brosis and foci of infarction necrosis.

16. Malignant Nephrosclerosis
CLINICAL FEATURES
• The patients of malignant nephrosclerosis have malignant or accelerated
hyper tension with blood pressure of 200/140 mmHg or higher.
Headache, dizziness and impaired vision are commonly found.
• presence of papilloedema distinguishes malignant from benign phase
of hypertension.
• urine frequently shows microscopic haematuria and proteinuria.
• Renal function tests show deterioration
• Azotaemia (high BUN and serum creati nine) and uraemia
• Approximately 90% of patients die within one year from causes such as
uraemia, congestive heart failure and cerebrovascular
accidents.