Malignant hypertension (arteriolar nephrosclerosis)

Alternative names:

accelerated hypertension; arteriolar nephrosclerosis; hypertension - malignant; nephrosclerosis - arteriolar

Symptoms:

• blurred vision
• headache
• change in mental status
  • restlessness
  • anxiety
  • decreased alertness, decreased ability to concentrate
  • fatigue
  • sleepy, stuporous, lethargic
  • confused, delirious

• chest pain
  • mid chest location most common
  • crushing or pressure sensation

• shortness of breath
• cough
• decreased urinary output
• nausea, 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:

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, acute renal failure may develop as a complication of malignant hypertension. Other complications may also develop.

Damage to the kidneys may be demonstrated by:

• a BUN increase
• a creatinine increase
• arterial blood gas analysis shows metabolic acidosis
• urinalysis shows high protein levels (especially with kidney impairment) or microscopic hematuria (blood in the urine)

A chest X-ray may indicate pulmonary (lung) congestion from fluid forced into the lungs by heart failure as a consequence of the high blood pressure.

This disease may also alter the results of the following tests:

• urinary casts
• renin
• aldosterone