‘Benign’ hypertensive nephrosclerosis

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Abstract

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.

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