Abstract:

ABSTRACT Objective：To investigate the renal outcome and its predictors in patients with biopsy-proven hypertensive nephrosclerosis (HN) , and to compare the clinico-pathological characteristics and prognoses of benign nephrosclerosis (BN) and malignant nephrosclerosis (MN). Methodology: One hundred seventy nine patients with biopsy-proven HN in Nanjing Jinling Hospital were enrolled in this retrospective study. According to the renal histological examination, they were divided into two groups: benign nephrosclerosis (HN, n=98), and malignant nephrosclerosis (MN, n=81). Their renal survival and the relationships between clinical and pathological parameters and outcome were assessed and compared. Results: They were male gender predominant (147 cases, 82%). At biopsy, the mean age was 43.8 years, the median duration of hypertension was 5.0 years, the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) was 197±36mmHg and 128±26mmHg, the median serum creatinine (Scr) and eGFR were 144.1μmol/L and 47.1ml/min/1.73m2, and median proteinuria was 0.77g/24h. At biopsy, benign nephrosclerosis (BN) was found in 54.7% and malignant nephrosclerosis (MN) was 45.3%. Compared with BN, the patients with MN were younger; they had higher levels of Scr, uric acid and proteinuria, and lower levels of hemoglobin; they also had a higher incidence of hypertensive heart disease and hypertensive retinopathy, and worse renal outcome. During a median follow-up of 2.9 years, 33 cases (18.4%) reached ESRD, and the 5- and 10-year cumulative renal survival after biopsy, as calculated by K-M methods, were 82.6 and 38.4%. A decreased baseline eGFR, increased proteinuria, the presence of MN and an increased percentage of global sclerosis (GS) were the independent predictors of future ESRD. Conclusions: The renal outcome of HN patients was independently associated with the baseline eGFR and proteinuria, presence of MN and percentage of GS. The clinico-pathological characteristics and prognoses were of significant difference between patients with MN and BN.

Key words:  hypertensive nephrosclerosis, malignant nephrosclerosis, benign nephrosclerosis, renal survival, risk factor