A condition that is most often related to chronic hypertension. It involves the vascular, glomerular tubules and interstitial tissues of the renal system. Hardening of the smaller arterioles culminates in deterioration, loss of blood supply, and ultimate failure.

The disorder occurs with normal aging, but is aggravated by chronic hypertension. Three factors that increased the risk of developing nephrosclerosis are: black race, moderate to severe hypertension, and other fundamental renal diseases.

The disorder manifests with chronic hypertension usually occurring along with retinopathy, enlargement of the left ventricle of the heart, a relatively normal urinalysis, and small kidneys.

A slow, progressive elevation in the blood urea nitrogen (BUN) and plasma creatinine concentration may occur. Patients may show an elevated level of uric acid in the blood early on in the disorder, as well as increased levels of proteinuria. Urinalysis typically shows few cells or casts. Other diagnoses are excluded since hypertension precedes the presence of proteinuria or renal failure. A renal biopsy helps to confirm the diagnosis, but is usually not necessary.

Hypertension is treated to decrease the blood pressure (BP) to a diastolic BP of 90 mm of mercury or less to prevent further renal injury.

The rate of progression is slow. Very few patients with hypertension, without recognizable cause, develop advanced renal disease. The progression of renal insufficiency depends on the severity of the hypertension and how well it is controlled.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 38 CFR 3.309 .  [Disease subject to presumptive service connection], 38 CFR 3.309(a) [chronic disease].

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See 38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• The new criteria for the Genitourinary Disease and Conditions body system became effective November 14, 2021.  Review both current and historic criteria prior to any reduction for disabilities established before that date.  38 CFR 3.951(a)

• When evaluating any claim involving loss or loss of use of one or more creative organs, refer to 38 CFR 3.350 of this chapter to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.