Nephrosclerosis - arteriolar

Alternative names

Accelerated hypertension; Arteriolar nephrosclerosis; Malignant hypertension; Hypertension - malignant

Definition

Malignant hypertension is usually defined as very high blood pressure with swelling of the optic nerve behind the eye, called papilledema (grade IV Keith-Wagner hypertensive retinopathy). Malignant hypertension is usually accompanied by other organ damage like heart failure, kidney failure, and hypertensive encephalopathy.

Causes, incidence, and risk factors

The disorder affects about 1% of people with high blood pressure, including both children and adults. It is more common in younger adults, especially African American men. It also occurs in women with toxemia of pregnancy, and people with kidney disorders or collagen vascular disorders. You are at high risk for malignant hypertension if you have had kidney (renal) failure or renal hypertension caused by renal artery stenosis.

Malignant hypertension is a medical emergency. Many body systems are in serious risk due to the extreme elevation of blood pressure. Multiple organs of the body, including the brain, eyes, blood vessels, heart, and kidneys may sustain damage. The blood vessels of the kidney are highly susceptible to damage caused by pressure, and kidney failure may develop, which may be permanent.

Symptoms

• blurred vision
  
• headache
  
• change in mental status
  o restlessness
  o anxiety
  o decreased alertness, decreased ability to concentrate
  o fatigue
  o sleepy, stuporous, lethargic
  o confused, delirious
  
• chest pain
  o mid chest location most common
  o crushing or pressure sensation
  
• shortness of breath
  
• cough
  
• decreased urinary output
  
• nausea or vomiting
  
• seizure
  
• weakness of the arms, legs, face, or other areas
  
• abnormal sensation (numbness) of the arms, legs, face, or other areas
  

Signs and tests
Your blood pressure may be extremely high. An eye examination will reveal changes that indicate high blood pressure, including papilledema (swelling of the optic nerve), retinal bleeding, or infarction (cotton wool spots or soft exudate - fluid with cellular debris) in the retina. If not already present, kidney failure may develop as a complication of malignant hypertension. Other complications may also develop.