the main
about the project
Medicine news
To authors
Licensed books on medicine
<< Ahead Next >>

Malignant phase of hypertension (malignant nephrosclerosis)

Malignant nephrosclerosis is a kidney disease associated with the malignant or accelerated phase of hypertension. Hypertension of this type usually develops in previously normotensive patients, and also often in patients who have previously suffered from essential benign hypertension, secondary forms of hypertension or chronic renal diseases, especially glomerulonephritis and reflux nephropathy. It is also a common cause of uraemia and death of patients with scleroderma. Malignant hypertension is a relatively rare disease, it is observed only in 1–5% of all individuals with high blood pressure, usually affects younger people, and is characterized by a higher predisposition to it for men.

Malignant hypertension is associated with high levels of renin, angiotensin and aldosterone. Any stimulus that causes hyperreninemia leads to vasospasm and an increase in blood pressure, followed by necrosis of the vessels of the kidneys and other organs. Such an increase in blood pressure causes endothelial damage, thrombosis, fibrinoid necrosis and intravascular coagulation. For malignant hypertension with ischemia, the vicious cycle of hyperreninemia is included. An increase in the content of other vasoconstrictors (for example, endothelin) or a decrease in the concentration of vasodilators (for example, nitric oxide) causes spasm and vascular damage. Any mechanism of malignant hypertension leads to renal failure due to renal ischemia due to narrowing of the arteries and arterioles.

The size of the kidneys depends on the susceptibility to the disease and the severity of hypertension.
Small petechial hemorrhages, having the appearance of flea bites, are found on the cortical surface of the kidneys and are associated with ruptures of the arterioles or capillaries of the glomeruli. For malignant hypertension, two types of damage to the blood vessels are described:

• fibrinoid necrosis of arterioles, manifested as eosinophilic granular changes in the wall of blood vessels, which are stained with fibrin. In addition, inflammatory infiltration is often found in the vessel wall, indicating the development of necrotizing arteriolitis;

• intimal thickening in the interlobular arteries and arterioles caused by the proliferation of elongated, concentrically located cells and smooth muscle cells simultaneously with the appearance of thin layers of concentrically arranged collagen fibers. These changes are called concentric arteriolitis, as well as bulbous arteriolitis. They correlate well with renal insufficiency in malignant hypertension. Sometimes the glomeruli are necrotized and infiltrated with neutrophils, the capillaries of the glomeruli are thrombosed (necrotizing glomerulonephritis) (Fig. 18.17). Damage to the arteries and arterioles leads to a malignant narrowing of the lumen of the vessels with ischemic atrophy and heart attack, developing distal to the affected vessels.

Fig. I8. 17

Malignant nephrosclerosis


<< Ahead Next >>
= Go to tutorial content =

Malignant phase of hypertension (malignant nephrosclerosis)

  1. Malignant AH
    Malignant hypertension, or the malignant phase of hypertension, is a syndrome that is characterized by a high level of blood pressure (typically> 220/120 mmHg) with hemorrhages and exudates in the retina, often with optic nerve edema. Characteristic (but not mandatory) is kidney damage with the development of uremia. Malignant course is most often noted in secondary hypertension (in 25% of cases), with
  2. Malignant AH
    is rare. In malignant hypertension, extremely high blood pressure is observed (> 180/120 mmHg) with the development of severe changes in the vascular wall (fibrinoid necrosis), which leads to hemorrhages and / or edema of the optic nerve, tissue ischemia and dysfunction of various organs. The transition of hypertension to the malignant form is possible in all its forms, but more often it occurs in patients with
  3. Malignant tumors
    SARCOMA is a malignant tumor from mesenchymal tissue. Unlike cancer of sarcoma, the first metastasis is hematogenous. Histogenesis sarcomas are classified into a number of varieties. From fibrous tissue. 1. Fibrosarcoma. 2. Bulging dermatofibroma (malignant histiocytoma) - unlike other sarcomas, it is characterized by slow growth and does not metastasize for a long time, although it grows
  4. Malignant tumors
    Malignant tumors of the nose and paranasal sinuses occupy the third place among other malignant lesions of the upper respiratory tract (larynx and pharynx) and constitute, according to literary data, 2 - 3% of malignant tumors of all localizations. Malignant tumors most often develop in the maxillary sinus. In the second place in frequency are tumors of the ethmoid labyrinth.
  5. Malignant Neuroleptic Syndrome
    Neuroleptic malignant syndrome is a rare complication that develops several hours or weeks after the use of antipsychotic drugs (sometimes - after the use of metoclopramide). The mechanism of complications is due to the dopaminergic blockade of the basal ganglia and the hypothalamus, as well as the violation of thermoregulation. Symptoms include muscle rigidity, hyperthermia,
  6. Malignant Hyperthermia
    Malignant hyperthermia, as a rule, appears completely unexpectedly. This syndrome is not a disease of thermoregulation, but is a syndrome of hypermetabolism. A presumptive diagnosis of malignant hyperthermia can be made without the symptom of hyperthermia: if you expect a rise in body temperature, you can lose valuable time that cannot be returned. The role of drugs for
  7. Malignant swelling
    Malignant edema (lat - Oedema malignum, septicaemia gangrenosa;. Eng - Malignant oedema, gas gangrena, big head;. Wound gas edema, gas gangrene) - acute flowing non-communicable wound poisoning of animals and humans caused by a group of pathogenic Clostridium and characterized by inflammatory swelling with the formation of gases, necrosis of the affected tissues and intoxication of the body
  8. Malignant tumors
    In the upper respiratory tract mainly cancer is found in various forms and is rare (about 3% in relation to malignant tumors of the upper respiratory tract)
    Thomas B. Fitzpatrick, Arthur J. Sober, Martin S. Mime Primary malignant melanoma of the skin is the most common cause of death from all skin cancers, so identifying its early signs is the primary task of any doctor, regardless of the profile of a specialist. Every time the doctor has the opportunity to examine the patient’s skin, he should
  10. Prevention of malignant neoplasms
    With exercise and temperance, most people can do without medicine. Joseph Addison Malignant neoplasms. Carcinogens. Every year in the Russian Federation, 300,000 people die from cancer, and the number of cases of malignant tumors in the last 5 years has increased by 4.5% per year. Cancer cells - malignant
Medical portal "MedguideBook" © 2014-2016