title: Glomerular Density in Biopsy-Proven Hypertensive Nephrosclerosis.
abstract: BACKGROUND
  Previous autopsy studies suggested that a reduced nephron number is associated with increased risk of hypertension and chronic kidney disease. However, the significance of the nephron number estimated from a renal biopsy in patients with hypertensive nephrosclerosis (HNS) has not yet been elucidated.
  
  
  METHODS
  In this cross-sectional study, we examined the clinicopathological findings of biopsy-proven HNS patients with preserved renal function (estimated glomerular filtration rate ≥ 60 ml/min/1.73 m(2)). The glomerular density (GD; the number of glomeruli per total renal cortical area) in biopsy specimens was evaluated as a surrogate of the nephron number. Renal biopsies from kidney transplant donors were used as healthy controls.
  
  
  RESULTS
  A total of 58 HNS patients were enrolled. The GD value in the HNS patients was low compared with those in the kidney transplant donors (2.0 vs. 3.2 /mm(2)). These differences remained significant when globally sclerotic glomeruli were included in the calculation of the GD. Of note, the GD in HNS patients with overt proteinuria (≥1 g/day) was significantly lower than that of HNS patients with mild proteinuria (<1g/day; 1.8 vs. 2.2/mm(2), P = 0.014). In contrast, other histopathological parameters, including the severity of global glomerulosclerosis, interstitial fibrosis/tubular atrophy and arterial and arteriole lesions were comparable between the 2 HNS subgroups. In addition, the GD was identified as a factor that was associated with the amount of urinary protein excretion at biopsy, independent of other clinicopathological factors.
  
  
  CONCLUSIONS
  These results suggest that a low GD is a renal histological characteristic of HNS patients, especially those with overt proteinuria.
authors: Department of Internal Medicine, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
authors: Kotaro
authors: K
authors: Haruhara
authors: Department of Internal Medicine, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan. tsuboi-n@jikei.ac.jp.
authors: Nobuo
authors: N
authors: Tsuboi
authors: Department of Internal Medicine, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
authors: Go
authors: G
authors: Kanzaki
authors: Department of Internal Medicine, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
authors: Kentaro
authors: K
authors: Koike
authors: Department of Internal Medicine, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
authors: Masahiro
authors: M
authors: Suyama
authors: Department of Internal Medicine, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
authors: Akihiro
authors: A
authors: Shimizu
authors: Department of Internal Medicine, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
authors: Yoichi
authors: Y
authors: Miyazaki
authors: Department of Internal Medicine, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
authors: Tetsuya
authors: T
authors: Kawamura
authors: Department of Internal Medicine, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
authors: Makoto
authors: M
authors: Ogura
authors: Department of Internal Medicine, Division of Nephrology and Hypertension, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
authors: Takashi
authors: T
authors: Yokoo
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis; D007678:Kidney Glomerulus / Q000473:pathology* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009400:Nephrosclerosis / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: blood pressure; glomerular density; glomerular hypertension; hypertension; hypertensive nephrosclerosis; nephron number; proteinuria; renal biopsy.