title: Clinico-pathological characteristics and outcomes of patients with biopsy-proven hypertensive nephrosclerosis: a retrospective cohort study.
abstract: BACKGROUND
  This study aimed to investigate renal outcomes and their predictors in biopsy-proven hypertensive nephrosclerosis (HN) patients and to compare clinico-pathological characteristics and prognoses between benign nephrosclerosis (BN) and malignant nephrosclerosis (MN) patients.
  
  
  METHODS
  Data for biopsy-proven HN patients were retrospectively analyzed. Renal survival rates and relationships between clinico-pathological characteristics and outcomes were assessed.
  
  
  RESULTS
  A total of 194 patients were enrolled; the mean age at biopsy was 43.8 years, and male gender predominated (82.5 %). The median duration of hypertension was 5.0 years, and the mean systolic and diastolic blood pressures were 195 ± 37 and 126 ± 26 mmHg, respectively. The median serum creatinine (Scr) level, estimated glomerular filtration rate (eGFR), and proteinuria level were 1.61 mg/dl, 49.6 ml/min/1.73 m(2), and 0.80 g/24 h, respectively. BN and MN were found by renal biopsy in 55.2 % and 44.8 % of patients, respectively. At biopsy, MN patients were younger, and had higher median Scr and proteinuria levels, higher incidences of anemia, hypertensive heart disease and hypertensive retinopathy, and worse renal outcomes than BN patients. During a median follow-up period of 3.0 years, 36 patients (18.6 %) reached end-stage renal disease (ESRD), and the 5- and 10-year cumulative renal survival rates for HN patients were 84.5 % and 48.9 %, respectively. A decreased baseline eGFR, an increased baseline proteinuria level, anemia, increased percentage of global glomerulosclerosis and tubular atrophy and interstitial fibrosis (TAIF) were independent predictors of future ESRD.
  
  
  CONCLUSIONS
  The clinico-pathological characteristics and prognoses were significantly different between the MN and BN patients. The renal outcomes of HN patients were independently associated with the baseline eGFR and proteinuria level, anemia, percentage of global glomerulosclerosis and TAIF.
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, East 305 Zhongshan Road, Nanjing, Jiangsu, 210002, China. southerns007@126.com.
authors.forename: Shaoshan
authors.initials: S
authors.lastname: Liang
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, East 305 Zhongshan Road, Nanjing, Jiangsu, 210002, China.
authors.forename: Weibo
authors.initials: W
authors.lastname: Le
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, East 305 Zhongshan Road, Nanjing, Jiangsu, 210002, China.
authors.forename: Dandan
authors.initials: D
authors.lastname: Liang
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, East 305 Zhongshan Road, Nanjing, Jiangsu, 210002, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, East 305 Zhongshan Road, Nanjing, Jiangsu, 210002, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, East 305 Zhongshan Road, Nanjing, Jiangsu, 210002, China.
authors.forename: Huiping
authors.initials: H
authors.lastname: Chen
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, East 305 Zhongshan Road, Nanjing, Jiangsu, 210002, China.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Liu
authors.affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, East 305 Zhongshan Road, Nanjing, Jiangsu, 210002, China. zengch_nj@hotmail.com.
authors.forename: Caihong
authors.initials: C
authors.lastname: Zeng
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology; D001284:Atrophy; D001706:Biopsy; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D005919:Glomerular Filtration Rate; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications*; D058437:Hypertensive Retinopathy / Q000209:etiology; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D007684:Kidney Tubules / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D011507:Proteinuria; D012189:Retrospective Studies
chemical_list: D003404:Creatinine
keywords: Benign nephrosclerosis; Hypertension; Malignant nephrosclerosis; Renal survival; Risk factors