Nationwide multicenter kidney biopsy study of Japanese patients with hypertensive nephrosclerosis.
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Furuichi Kengo, Shimizu Miho, Yuzawa Yukio, Hara Akinori, Toyama Tadashi, Kitamura Hiroshi, Suzuki Yoshiki, Sato Hiroshi, Uesugi Noriko, Ubara Yoshifumi, Hoshino Junichi, Hisano Satoshi, Ueda Yoshihiko, Nishi Shinichi, Yokoyama Hitoshi, Nishino Tomoya, Kohagura Kentaro, Ogawa Daisuke, Mise Koki, Shibagaki Yugo, Kimura Kenjiro, Haneda Masakazu, Makino Hirofumi, Matsuo Seiichi, Wada Takashi, Research Group of Diabetic Nephropathy and Nephrosclerosis, Ministry of Health, Labour and Welfare of Japan, and Japan Agency for Medical Research and Development
Аннотация
METHODS: Clinical and pathologic data of a total of 184 biopsy-confirmed hypertensive nephrosclerosis patients were collected from 13 centers throughout Japan. Seven pathological findings were assessed in this study. The outcomes of interest for this study were dialysis, composite kidney events, cardiovascular events, and all-cause mortality.
RESULTS: The Green and Yellow (G&Y), Orange, and Red groups of the chronic kidney diseases (CKD) heat map contained 36, 57, and 91 cases, respectively. The mean observation period was 7.3 ± 5.2 (median, IQR; 6.1, 2.6-9.7) years. Global glomerulosclerosis (GScle), interstitial fibrosis and tubular atrophy (IFTA), arteriolar hyalinosis in Red exhibited higher scores than those in G&Y and Orange. The incidence rates of the composite kidney end points in 100 person-years for the G&Y, Orange, and Red groups were 1.42, 2.16, and 3.98, respectively. In the univariate Cox analysis for the composite kidney end points, GScle, IFTA and interstitial cell infiltration exhibited statistically significant high hazard ratios (1.18, 1.84, 1.69, respectively). However, after adjustment for clinical and medication data, the Red group in the CKD heat map category was risk factor for the composite kidney end points (HR 9.51).
CONCLUSIONS: In summary, although pathologic findings had minor impacts on the prediction of composite outcomes in this study, the clinical stage of the CKD heat map is a good predictor of composite kidney events.