CLINICAL-FEATURES OF BENIGN HYPERTENSIVE NEPHROSCLEROSIS AT TIME OF RENAL BIOPSY

Although hypertension accounts for approximately 15-20% of end-stage r enal disease and renal impairment occurs in 15% of patients with essen tial hypertension, there are few data available on the clinical featur es of patients with benign hypertensive nephrosclerosis, the histologi cal consequence of hypertension on the kidney. To determine its preval ence on renal biopsy and its clinical features (including proteinuria and renal function), we used the U.K. MRC Glomerulonephritis Registry of 7339 biopsies from 20 centres to define all patients with benign hy pertensive nephrosclerosis. In patients with no co-existing disease, 1 85 biopsies were classified solely as benign hypertensive nephrosclero sis (2.5%). Sixty-nine percent of patients were male and 72% aged over 50 years. Sixty-four percent had diastolic blood pressure above 90 mm Hg and severe hypertension (diastolic > 120 mmHg) was present in 9%. P rotein excretion of > 1.5 g/day was noted in 40%, with 22% excreting > 3 g/day. Eighteen percent had serum albumin values under 30 g/l. Eigh ty-one percent had serum creatinine > 120 mumol/l; in 51% this was > 2 50 mumol/l. There was significant correlation between serum creatinine and systolic blood pressure at time of biopsy (p=0.01) and between se rum creatinine and serum albumin (p=0.001). Benign hypertensive nephro sclerosis accounts for 2.5% of all registered biopsies. Significant pr oteinuria is a common finding and proteinuria within the nephrotic ran ge does occur. Systolic blood pressure appears to influence serum crea tinine levels. Hypertensive nephropathy should be considered in all pa tients with heavy proteinuria and renal impairment.