RAPID PROGRESSION TO END-STAGE RENAL-DISEASE IN YOUNG HYPERTENSIVE AFRICAN-AMERICANS WITH PROTEINURIA

Hypertensive nephrosclerosis (HN) remains the most common cause of end -stage renal disease (ESRD) in blacks. This study examined whether ren al histology corresponds with clinical hypertension in proteinuric bla cks. Nondiabetic hypertensive blacks who satisfied inclusion criteria were enrolled in this study. Four male patients, each with a family hi story of hypertension and mean age 41 years, consented to kidney biops y. Their mean arterial pressure was 116.5 mm Hg, mean urine protein ex cretion was 7.7+/-3.5 g/day. All patients progressed to ESRD within a mean duration of 14 months; the mean rate of decline in glomerular Fil tration rate was 53 mL/min/y, with an ESRD incidence of 80%/y. The his tologic findings were consistent with previously described features of HN. Prominent glomerulosclerosis involved 30% to 75% of the glomeruli and extensive arteriolosclerosis/arteriosclerosis, tubular atrophy, a nd interstitial fibrosis. There was no evidence of immune complex dise ase by either immunofluorescence, electron microscopy, or serologic st udies. The mean arterial pressure showed a strong but nonsignificant c orrelation with progression to ESRD (r=0.8) and arteriosclerosis/arter iolosclerosis (r=0.8). Glomerular sclerosis correlated with the recipr ocal of serum creatinine (r=0.6), interstitial fibrosis (r=0.8), and a rteriosclerosis/arteriolosclerosis (r=0.3). Urine protein excretion co rrelated weakly with progression to ESRD (r=0.4). These results indica te a poor correlation between clinical findings and histologic feature s on renal biopsy in young hypertensive African Americans. Hypertensio n remains a major cause of ESRD among African Americans, and progressi on to ESRD may be rapid in patients with marked proteinuria. Early and aggressive intervention is warranted.