'Benign' hypertensive nephrosclerosis

Abstract

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. Aim: To investigate whether biopsy-proven BHN leads to ESRF. Design: 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 m2, serum creatinine 280±165 vs. 161±89 μmol/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). Discussion: Biopsy-proven BHN led to ESRF in a high percentage of our patients, and was associated with significant mortality. © 2007 Oxford University Press.