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.

journal_name

Am J Hypertens

authors

Haruhara K,Tsuboi N,Kanzaki G,Koike K,Suyama M,Shimizu A,Miyazaki Y,Kawamura T,Ogura M,Yokoo T

doi

10.1093/ajh/hpu267

subject

Has Abstract

pub_date

2015-09-01 00:00:00

pages

1164-71

issue

9

eissn

0895-7061

issn

1941-7225

pii

hpu267

journal_volume

28

pub_type

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