Benign nephrosclerosis: incidence morphology and prognosis

Citation
S. Takebayashi et al., Benign nephrosclerosis: incidence morphology and prognosis, CLIN NEPHR, 55(5), 2001, pp. 349-356
Citations number
21
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Urology & Nephrology","da verificare
Journal title
CLINICAL NEPHROLOGY
ISSN journal
0301-0430 → ACNP
Volume
55
Issue
5
Year of publication
2001
Pages
349 - 356
Database
ISI
SICI code
0301-0430(200105)55:5<349:BNIMAP>2.0.ZU;2-I
Abstract
Aims: Study of benign nephrosclerosis (BNS) is often mixed up with IgA neph ritis (IgAN) associated with hypertension or thin basement membrane disease (TBMD). Here we examined the clinicopathological features, incidences and prognosis of decompensated BNS. Materials and methods: BNS was identified i n 590 (8.3%) adult cases among 7108 renal biopsies of a mean age of 56.5 ye ars (male: female ratio = 2.5:1), The post-biopsy follow-up period ranged f rom 3 to 22 years (10.1 +/- 4.6 years). Results: Patients with progressive BNS were more likely to develop end-stage renal disease within 5 years of b iopsy. Poor prognostic factors included poor or no control of arterial bloo d pressure by anti-hypertensive drugs, global glomerulosclerosis (GS) (grea ter than or equal to 41%) at biopsy, presence of collapsed glomeruli and/or segmented or semi-global GS. Tubulointerstitial damage, glomerular hypertr ophy and loop dilatation were secondary to GS. Gender, duration of HT and o nset of HT to biopsy were not significant factors. Conclusion: GS in BNS is due to ischemia induced by luminal narrowing or obstruction of preglomerul ar vessels, and glomerular HT due to loss of autoregulation in preglomerula r vessels (irregularly shaped atrophic or segmented medial smooth muscle ce lls, with expansion of extracellular matrix with or without fibrous intimal thickening). GS resulted in luminal dilatation. Both pathological changes affecting the glomerulus may occur in the same kidney and different nephron units.