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(Hypertension. 2001;38:171.)
© 2001 American Heart Association, Inc.

Scientific Contributions

Hypertensive Nephrosclerosis as a Relevant Cause of Chronic Renal Failure

Edna Regina Silva Pereira Caetano; Roberto Zatz; Luís Balthazar Saldanha; José Nery Praxedes

From the Renal Division, Department of Clinical Medicine (E.R.S.P.C., R.Z., J.N.P.), and the Department of Pathology, Faculty of Medicine (L.B.S.), University of São Paulo, São Paulo, Brazil

Correspondence to Roberto Zatz, MD, PhD, Laboratório de Fisiopatologia Renal, Av. Dr. Arnaldo, 455, 3-s/3342, 01246-903 São Paulo SP, Brazil. E-mail rzatz{at}usp.br

Abstract—— It is currently unclear whether hypertensive nephrosclerosis (HN), usually diagnosed solely on clinical grounds, is a relevant cause of end-stage renal disease. We biopsied 81 hypertensive outpatients (blood pressure 160/95 mm Hg) with moderate renal insufficiency, who were referred to our service from 1988 to 1998. Patients with known causes of hypertension, systemic disorders, rheumatic disease, or nephrotic syndrome were excluded. In 65% of patients, HN was the sole histological abnormality associated with renal dysfunction. Benign nephrosclerosis (BN), defined as isolated arteriolar hyalinosis and/or intimal fibrosis, was found in 18 HN patients (22%), whereas malignant nephrosclerosis (MN), denoted mainly by myointimal cell proliferation, appeared in 35 HN patients (43%). Previously undiagnosed primary nephritis (PN) was found in 13 patients (16%), whereas focal and segmental glomerulosclerosis, which might be either primary or secondary to hypertension, appeared in 15 patients (19%). These findings suggest 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.

Key Words: nephrosclerosis • hypertension, essential • kidney • renal disease

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