1. Scarring of the kidney because of arteriolar sclerosis (hardening from inflammation and in diseases of the interstitial substance) resulting from chronic hypertension.
2. The destructive changes that occur in the blood vessels of the kidney as a result of severe hypertension (malignant hypertension or a severe form of acute hypertension that results in the abrupt rise in blood pressure).

Prolonged hypertension can result in renal failure.