THE SIGNIFICANCE OF ARTERIAL-HYPERTENSION AT THE ONSET OF CLINICAL LUPUS NEPHRITIS

The prognostic importance of hypertension at the onset of clinical lup us nephritis is mot well established. We studied retrospectively 44 pa tients with lupus nephritis in order to ascertain the prevalence of hy pertension at presentation and to investigate a possible association b etween hypertension and renal functional impairment. A correlation was also sought between hypertension and histological class of lupus neph ritis. Hypertension was graded as mild diastolic 95-99 mmHg), moderate (100-114) or severe (>115). Impaired renal function (creatinine >120 mu mol/l) was graded as mild (120-200 mu mol/l), moderate (200-350 mu mol/l), or severe (>350 mu mol/l). Histological class and the presence of hypertensive renal vascular lesions was recorded. The prevalence o f hypertension was 38%. There were 17 hypertensives and 27 normotensiv es. The incidence of renal impairment was greater in the hypertensives , 47% vs 18.5% (p=0.04). Mean serum creatinine was also higher higher in this group (p=0.02). The presence of hypertensive renal vascular le sions identified a high-risk subgroup who had a higher incidence of re nal functional impairment and worse renal function than the hypertensi ve group as a whole. Even at an early stage, hypertension and hyperten sive renal vascular lesions correlated well with renal functional impa irment. Aggressive treatment of hypertension is therefore essential in early lupsus nephritis in order to prevent further deterioration of r enal function as the disease evolves.