Hypertensive nephropathy risk factors

• High systolic blood pressure is a very strong risk factor for the development of hypertensive nephrosclerosis.
• African Americans are more likely to develop hypertensive nephropathy. Firstly, a number of causes had been suggested:
  • Higher prevalence and severity of hypertension
  • Lower socioeconomic status
  • Poor healthcare accessibility.
• However, Ethnic differences related to hypertensive nephropathy remained after adjusting age, sex, and prevalence of hypertension among ethnic groups, suggesting the presence of genetic predisposition in this population.^[1]

• Genetic susceptibility
  • Non-muscle myosin heavy chain 9 gene (MYH9), which regulates the function of podocyte cytoskeleton, is associated with hypertensive ESRD in African Americans.^[2]
  • Solidified glomerulosclerosis secondary to hypertension in African American is associated with apolipoprotein L1 gene (APOL1)^[3]
  • Chromogranin A gene variants, which block secretion of catecholamine, is also contributed to hypertensive ESRD in African Americans.^[4]

• The Framingham heart study showed that a combination of hypertension with a mild reduction in glomerular filtration rate increases the risk of developing chronic renal failure.

• Diabetes, smoking, obesity and high levels of low density lipoproteins also accelerates the progression of renal damage secondary to hypertension.

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