Hypertensive nephrosclerosis as a relevant cause of chronic renal failure

It is currently unclear whether hypertensive nephrosclerosis (HN), usually diagnosed solely on clinical grounds, is a relevant cause of end-stage rena l disease. We biopsied 81 hypertensive outpatients (blood pressure greater than or equal to 160/95 mm Hg) with moderate renal insufficiency, who were referred to our service from 1988 to 1998. Patients with known causes of hy pertension, systemic disorders, rheumatic disease, or nephrotic syndrome we re excluded. In 65% of patients, HN was the sole histological abnormality a ssociated with renal dysfunction. Benign nephrosclerosis (BN), defined as i solated arteriolar hyalinosis and/or intimal fibrosis, was found in 18 HN p atients (22%), whereas malignant nephrosclerosis (MN), denoted mainly by my ointimal cell proliferation, appeared in 35 HN patients (43%). Previously u ndiagnosed primary nephritis (PN) was found in 13 patients (16%), whereas f ocal and segmental glomerulosclerosis, which might be either primary or sec ondary to hypertension, appeared in 15 patients (19%). These findings sugge st that HN, in both its BN and MN forms, can be a definite cause of chronic renal insufficiency and that a substantial fraction of patients with renal insufficiency and clinical diagnosis of HN may actually have PN.