"Benign" hypertensive nephrosclerosis.
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.


OBJECTIVE
To investigate whether biopsy-proven BHN leads to ESRF.


METHODS
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 m(2), serum creatinine 280 +/- 165 vs. 161 +/- 89 mumol/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).


CONCLUSIONS
Biopsy-proven BHN led to ESRF in a high percentage of our patients, and was associated with significant mortality.
Dasgupta
I
I
Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS. indranil.dasgupta@heartofengland.nhs.uk
Porter
C
C
Innes
A
A
Burden
R
R
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006977:Hypertension, Renal / Q000097:blood / Q000209:etiology* / Q000473:pathology; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000097:blood / Q000150:complications* / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis
D015415:Biomarkers; D003404:Creatinine