Patient handout

Hypertensive Nephrosclerosis (HTN-CKD)

PRODUCTION

1. Your condition

This handout is for hypertensive nephrosclerosis (htn-ckd). Your care team identified this based on: declining egfr in long-standing htn patient ± modest albuminuria (kdigo 2012 ckd).

Other reasons your team may use this plan: persistent uacr 30-300 + chronic htn (no diabetes) — hypertensive ckd phenotype (kdigo 2012 ckd); long-standing uncontrolled htn ≥10 yrs (kdigo 2012 ckd; aha 2017); african-ancestry patient with htn-ckd — apol1 high-risk substrate evaluation.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
lisinopril	10 mg PO daily; titrate to max 40 mg	PO	daily	KDIGO 2012 CKD — RAS blockade slows progression; titrate to max-tolerated dose; recheck Cr+K at 1-2 wk
losartan	50 mg PO daily; titrate to 100 mg	PO	daily	KDIGO 2012 CKD — ARB if ACEi intolerant; same renoprotective effect

Plan: Hypertensive nephrosclerosis — BP control + renoprotection tier ladder + malignant HTN STAT pathway (KDIGO 2012 CKD; SPRINT NEJM 2015; DAPA-CKD; EMPA-KIDNEY)

3. When to call your provider

Contact your care team if any of the following happen:

Sustained BP >150/95 despite max tier → resistant HTN workup → cardio.htn.resistant.v1
Rapid eGFR decline (>5 ml/min/year) → biopsy consideration (KDIGO 2012 CKD)
New nephrotic UACR → renal.fsgs.v1 or biopsy for APOL1-FSGS overlap

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

African-ancestry adult with HTN-CKD + APOL1 high-risk G1/G2 genotype — 7-10× progression amplification
BP >180/120 + AKI + MAHA + thrombocytopenia + grade III/IV retinopathy → STAT IV BP reduction + plasmapheresis if TMA (AHA 2017; KDIGO 2012 AKI)(life-threatening)
Asymmetric kidneys + refractory HTN + flash pulm edema + atherosclerotic burden — atherosclerotic RAS (ASTRAL; CORAL)
Young woman + refractory HTN + asymmetric kidneys / string-of-beads on angio — FMD (Olin-Sealove Mayo Clin 2010)
African-ancestry + nephrotic-range UACR + APOL1+ — collapsing FSGS variant overlap (KDIGO GN 2021)
Sickle cell disease + HTN + progressive CKD — sickle nephropathy overlay (KDIGO 2012 CKD; ASH 2014)

5. Follow-up

q3-6 mo nephrology; transplant + RRT planning at G4 (eGFR <30); cardiology co-management for CV; ophtho for retinopathy; patient education on BP self-monitoring + lifestyle (KDIGO 2012 CKD; AHA 2017)

6. Sources

Guideline: KDIGO 2021 BP in CKD + KDIGO 2024 CKD + AASK (JAMA 2002) + SPRINT (NEJM 2015) + SGLT2i renal protection (EMPA-KIDNEY 2023)