A woman of 58 with a history of previous renal disease was admitted to hospital in a confused state. On examination, her blood pressure was 210/110. The urine contained considerable albumin, cellular and granular casts, and had a specific gravity of 1010. The blood urea was 40 mmol/L. Fitting developed, followed by death.
Slices of 2 contracted kidneys are mounted to display external and cut surfaces. The capsular surface is finely granular with occasional coarse scars. On the cut surface, the cortex is reduced to approximately 2 mm in thickness and is granular and pale. Sectioned arcuate arteries are thick walled and widely patent. This is an example of chronic glomerulonephritis.
The changes in the arcuate arteries are due to the associated systemic hypertension. Hypertension usually develops in chronic renal disease and contributes to the renal damage.