title: [Analysis of factors affecting the course of renal disease progression in patients with established renal insufficiency].
abstract: All renal diseases ultimately progress to end-stage renal disease after renal dysfunction develops except for acute renal failure or rapidly progressive glomerulonephritis. However, renal function can be preserved for long periods in patients with mild renal insufficiency. We examined the factors affecting the progression of renal disease in patients with established renal insufficiency. We enrolled 38 patients with renal insufficiency diagnosed at the first visit and who were followed up for at least 3 years. We retrospectively recorded all information relating to serum creatinine and blood pressure levels during the follow-up periods. The patients were categorized as group A(n = 11), long-term renal survivors(at least 8 years), group B(n = 22), short-term renal survivors(3 to 8 years) and others(n = 5). Basal renal diseases were variable, and included IgA nephropathy, membranous nephropathy, focal segmental glomerulosclerosis, hypertensive glomerulosclerosis, tubulo-interstitial disease and lupus nephritis. Except for the degree of urinary occult blood, no other clinical data obtained at the first visit differed between groups A and B. Overall blood pressure levels throughout the entire clinical course also did not differ between the two groups. However, mean blood pressure levels before serum creatinine had reached the level of 2.0 mg/dl were significantly lower in group A compared with group B (96 +/- 7.8 vs. 103 +/- 6.3 mmHg, p < 0.05). We considered that the serum creatinine level of the so-called "point of no return" might be 2.0 mg/dl. In conclusion, blood pressure should be strictly controlled before serum creatinine levels reach 2.0 mg/dl.
authors.affiliation: First Department of Internal Medicine, Miyazaki Medical College, Miyazaki, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sato
authors.forename: Shouichi
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamada
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Hara
authors.forename: Tanenao
authors.initials: T
authors.lastname: Eto
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D011379:Prognosis; D051437:Renal Insufficiency / Q000473:pathology / Q000503:physiopathology*