title: Relationship between diurnal blood pressure and renal histopathological changes in white coat hypertension.
abstract: BACKGROUND
  Multiple epidemiological studies have clearly demonstrated the macrovascular risks associated with white coat hypertension (WCH) or sustained hypertension (SH). In patients with WCH, there is no literature available on renal histopathological changes and that on blood pressure pattern and native kidney outcome is scant. We aimed to clarify the relationship between blood pressure variables and pathological features of kidney biopsies in living kidney donors with WCH.
  
  
  METHODS
  This cross-sectional study included living kidney donors with WCH (n = 10) and SH (n = 10), and 20 healthy kidney donors with similar demographic features (control group). Kidney allograft biopsy samples were obtained during transplantation and chronic glomerular, vascular and tubulointertitial changes were semiquantitatively scored according to the Banff classification.
  
  
  RESULTS
  The mean age of the 20 hypertensive subjects (Group 1) and controls (Group 2) was 59.3 ± 8.5 versus 59.6 ± 7.6 years and almost half were female. There was no difference in renal function parameters between the groups; however, kidney histopathology in Group 1 was worse than Group 2 with a chronicity index of 2.80 ± 1.67 versus 1.75 ± 1.16 (p = 0.02). There was no difference between histopathological scores of patients with WCH or SH (chronicity index: 2.60 ± 1.43 vs. 2.70 ± 1.70, p = 0.88). Night-to-day mean arterial pressure (MAP) ratio was significantly associated with chronicity index in patients with WCH. Moreover, WCH patients with non-dipper hypertensive pattern had a worse chronicity index.
  
  
  CONCLUSIONS
  Significant histopathological alterations in the kidney were observed in patients with WCH and SH, and were accentuated in WCH patients with non-dipper blood pressure pattern.
authors.affiliation: Department of Nephrology, Izmir Bozyaka Education and Research Hospital, Karabaglar, +9035170, Izmir, Turkey. etatar@hotmail.com.
authors.forename: Erhan
authors.initials: E
authors.lastname: Tatar
authors.affiliation: Department of General Surgery, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey.
authors.forename: Adam
authors.initials: A
authors.lastname: Uslu
authors.affiliation: Department of Pathology, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey.
authors.forename: Funda
authors.initials: F
authors.lastname: Tasli
authors.affiliation: Department of General Surgery, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Karatas
mesh_terms: D000368:Aged; D062186:Arterial Pressure; D001706:Biopsy; D016022:Case-Control Studies; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007674:Kidney Diseases / Q000209:etiology* / Q000473:pathology; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D059466:White Coat Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology
keywords: Blood pressure; Kidney donors; Kidney histopathology; Kidney transplantation; White coat hypertension