QJM Advance Access originally published online on January 23, 2007
QJM 2007 100(2):113-119; doi:10.1093/qjmed/hcl139
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‘Benign’ hypertensive nephrosclerosis
From the 1Birmingham Heartlands Hospital, Birmingham, 2Nottingham City Hospital, Nottingham and 3Crosshouse Hospital, Kilmarnock, UK
Address correspondence to Dr I. Dasgupta, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS. email: indranil.dasgupta{at}heartofengland.nhs.uk
Received 7 February 2006 and in revised form 19 October 2006
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Abstract |
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Background: Whether benign hypertensive nephrosclerosis (BHN) causes end-stage renal failure (ESRF) is controversial. One reason for this is the lack of biopsy evidence confirming the clinical diagnosis in most cases.
Aim: To investigate whether biopsy-proven BHN leads to ESRF.
Design: Retrospective analysis.
Methods: We analysed all cases of biopsy-proven BHN from a single centre over a period of 20 years (n = 60), followed-up for a mean ± SD 6.7 ± 5.5 years.
Results: Patients were divided into those with stable renal function (n = 17) and those with declining function (n = 43). Mean eGFR at the time of biopsy was lower in the declining function group (29 ± 3 vs. 44 ± 4 ml/min/1.73 m2, serum creatinine 280 ± 165 vs. 161 ± 89 µmol/l, p < 0.001), of whom 72% progressed to ESRF. Median renal survival for the whole group was 6.8 years, with 5- and 10-year survivals of 56% and 35%, respectively. Renal survival was significantly affected by initial serum creatinine, and mean systolic and diastolic blood pressures during follow-up period. Mean protein excretion was higher in the declining group, but not significantly so. On multivariate analysis, only diastolic blood pressure during follow-up predicted renal survival (p = 0.017). Median patient survival for the whole group was 9.95 years post renal biopsy, with 5- and 10-year survivals of 70% and 49% respectively. Survival was affected by initial serum creatinine, initial serum albumin and mean systolic blood pressure during follow-up. On multivariate analysis, only initial serum creatinine was significantly correlated with survival (p = 0.017).
Discussion: Biopsy-proven BHN led to ESRF in a high percentage of our patients, and was associated with significant mortality.