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Mr. Smith, aged 60 years, had hypertension for almost 20 years. Recently, his legs and feet are swollen, his weight has increased, headaches are frequent, he feels tired, and has lost his appetite. His blood pressure is 160/105, and he has elevated blood creatinine and urea levels. His urine is diluted. His hemoglobin is low, serum bicarbonate is low, and serum sodium is low.

-Has he developed nephrosclerosis?

-Why is he developing edema and gaining weight?

-Why is he voiding dilute urine?

-Why does he have anemia and metabolic acidosis?

-What should be the treatment?

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The following posting discusses nephrosclerosis.

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It is very likely that Mr. Smith has developed nephrosclerosis. Nephrosclerosis develops due to persistent high blood pressure (which Mr. Smith has had for 20 years). The high blood pressure damages the arteries and arterioles in the renal and glomerular regions. The damage to the blood vessels causes hyalin to build up. This causes the blood vessels to thicken and the lumen of the blood vessels to narrow. Because blood cannot adequately flow through the narrowed ...

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