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Agnes B. Fogo - One of the best experts on this subject based on the ideXlab platform.
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hypertensive Nephrosclerosis wider kidney biopsy indications may be needed to improve diagnostics
Journal of Internal Medicine, 2020Co-Authors: Stein Hallan, Marius Altern Ovrehus, Rune Bjorneklett, Knut Aasarod, Agnes B. FogoAbstract:BACKGROUND Hypertensive Nephrosclerosis is the presumed underlying cause in many end-stage kidney disease (ESKD) patients, but the diagnosis is disputed and based on clinical criteria with low diagnostic accuracy. OBJECTIVE To evaluate and improve the diagnostic process for Nephrosclerosis patients. METHODS We included adults from the population-based HUNT study (n = 50 552), Norwegian CKD patients referred for kidney biopsy 1988-2012 (n = 7261), and unselected nephrology clinic patients (n = 193) used for matching. Decision tree analysis and ROC curve-based methods of optimal cut-offs were used to improve clinical Nephrosclerosis criteria. RESULTS Nephrosclerosis prevalence was 2.7% in the general population, and eGFR decline and risk for kidney-related hospital admissions and ESKD were comparable to patients with diabetic kidney disease. In the biopsy cohort, current clinical criteria had very low sensitivity (0.13) but high specificity (0.94) for biopsy-verified arterioNephrosclerosis. A new optimized diagnostic algorithm based on proteinuria ( 155 mm Hg) and age (>75 years) only marginally improved diagnostic accuracy (sensitivity 0.19, specificity 0.96). Likewise, there were still false-positive cases with treatable diagnoses like glomerulonephritis, interstitial nephritis and others (40% of all test positive). Decision curve analysis showed that the new criteria can lead to higher clinical utility, especially for patients considering the potential harms to be close to the potential benefits, while the more risk-tolerant ones (harm:benefit ratio < 1:4) should consider kidney biopsy. CONCLUSION Further improvements of the current clinical criteria seem difficult, so risks and benefits of kidney biopsy could be more actively discussed with selected patients to reduce misclassification and direct treatment.
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Hypertensive Nephrosclerosis: wider kidney biopsy indications may be needed to improve diagnostics
Journal of internal medicine, 2020Co-Authors: Stein Hallan, Marius Altern Ovrehus, Rune Bjorneklett, Knut Aasarod, Agnes B. FogoAbstract:BACKGROUND Hypertensive Nephrosclerosis is the presumed underlying cause in many end-stage kidney disease (ESKD) patients, but the diagnosis is disputed and based on clinical criteria with low diagnostic accuracy. OBJECTIVE To evaluate and improve the diagnostic process for Nephrosclerosis patients. METHODS We included adults from the population-based HUNT study (n = 50 552), Norwegian CKD patients referred for kidney biopsy 1988-2012 (n = 7261), and unselected nephrology clinic patients (n = 193) used for matching. Decision tree analysis and ROC curve-based methods of optimal cut-offs were used to improve clinical Nephrosclerosis criteria. RESULTS Nephrosclerosis prevalence was 2.7% in the general population, and eGFR decline and risk for kidney-related hospital admissions and ESKD were comparable to patients with diabetic kidney disease. In the biopsy cohort, current clinical criteria had very low sensitivity (0.13) but high specificity (0.94) for biopsy-verified arterioNephrosclerosis. A new optimized diagnostic algorithm based on proteinuria ( 155 mm Hg) and age (>75 years) only marginally improved diagnostic accuracy (sensitivity 0.19, specificity 0.96). Likewise, there were still false-positive cases with treatable diagnoses like glomerulonephritis, interstitial nephritis and others (40% of all test positive). Decision curve analysis showed that the new criteria can lead to higher clinical utility, especially for patients considering the potential harms to be close to the potential benefits, while the more risk-tolerant ones (harm:benefit ratio
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Clinical Phenotypes and Long-term Prognosis in White Patients With Biopsy-Verified Hypertensive Nephrosclerosis.
Kidney international reports, 2019Co-Authors: Marius Altern Ovrehus, Agnes B. Fogo, Rune Bjorneklett, Knut Aasarod, Aydin Dadfar, Tine Simensen Oldereid, Stein HallanAbstract:Introduction Hypertensive Nephrosclerosis is considered the second most common cause of end-stage renal disease (ESRD), but it is still an insufficiently studied and controversial disease entity. More information on the phenotype and prognosis is needed to improve clinical diagnostics and treatment. Methods We included all Norwegian patients with chronic kidney disease (CKD) referred for kidney biopsy between 1988 and 2012 whose clinical presentation was consistent with, but not primarily suspicious for, hypertensive Nephrosclerosis (n = 4920); follow-up continued until 2013. Results A total of 918 patients (19%) had biopsy-verified hypertensive Nephrosclerosis (i.e., arterioNephrosclerosis). Their most common biopsy indications were proteinuria (57%), low estimated glomerular filtration rate (eGFR) (44%), hematuria (34%), or combinations of these indications. Multivariable logistic regression analysis revealed that arterioNephrosclerosis was significantly associated with higher age, male sex, not having diabetes, higher blood pressure, lower proteinuria, and not having hematuria (P 0.05 for all). The most common biopsy-verified diagnoses in patients fulfilling the clinical criteria for hypertensive Nephrosclerosis were arterioNephrosclerosis (40%), glomerulonephritis (22%), and interstitial nephritis (14%), reflecting that the criteria had low sensitivity (0.17) and high specificity (0.94). ESRD and mortality risks did not differ in patients with arterioNephrosclerosis compared to patients with glomerulonephritis, interstitial nephritis, or other relevant diagnoses (P > 0.1 for both), whereas patients with diabetic kidney disease had a 2-fold higher risk (P Conclusion ArterioNephrosclerosis is a high-risk disease, often with an atypical phenotype with proteinuria and hematuria contributing to low accuracy for current clinical criteria for hypertensive Nephrosclerosis.
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Nephrosclerosis and hypertension
2014Co-Authors: Agnes B. Fogo, Arthur H Cohen, Robert B Colvin, Charles J Jennette, Charles E AlpersAbstract:Approximately 60 million people in the United States have hypertension. Many are undiagnosed or untreated. Different populations have different risks and different consequences of hypertension. Increased hypertension is seen with aging, positive family history, African-American race, and exogenous factors such as smoking. Although African Americans make up only 12% of the U.S. population, they are fivefold overrepresented among patients with end-stage renal disease (ESRD) presumed due to hypertension (1,2). Hypertension is associated with significant morbidity and mortality due both to cardiovascular and renal diseases (1–5).
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Hypertensive risk factors in kidney disease in African Americans
Kidney International, 2003Co-Authors: Agnes B. FogoAbstract:Hypertensive risk factors in kidney disease in African Americans. African Americans with hypertension more commonly develop renal insufficiency compared to Caucasians. The African American Study of Kidney Disease (AASK) included a renal biopsy pilot study that demonstrated that the clinical diagnosis of so-called hypertensive Nephrosclerosis in these African American patients indeed was accurate. This biopsy study demonstrated extensive global glomerulosclerosis, far exceeding that expected for patients' age. We further compared our clinically indicated renal biopsies to determine if any phenotypic differences were present in hypertensive Nephrosclerosis in African Americans versus Caucasians. These studies point to an excess of the solidified type of global glomerulosclerosis (GS) (also called "decompensated benign Nephrosclerosis") in African Americans compared to more obsolescent type GS in Caucasians. We speculate that these phenotypic differences might reflect differing mechanisms of tissue injury in hypertensive African Americans versus Caucasians, and discuss possible contributors to this injury.
Stein Hallan - One of the best experts on this subject based on the ideXlab platform.
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hypertensive Nephrosclerosis wider kidney biopsy indications may be needed to improve diagnostics
Journal of Internal Medicine, 2020Co-Authors: Stein Hallan, Marius Altern Ovrehus, Rune Bjorneklett, Knut Aasarod, Agnes B. FogoAbstract:BACKGROUND Hypertensive Nephrosclerosis is the presumed underlying cause in many end-stage kidney disease (ESKD) patients, but the diagnosis is disputed and based on clinical criteria with low diagnostic accuracy. OBJECTIVE To evaluate and improve the diagnostic process for Nephrosclerosis patients. METHODS We included adults from the population-based HUNT study (n = 50 552), Norwegian CKD patients referred for kidney biopsy 1988-2012 (n = 7261), and unselected nephrology clinic patients (n = 193) used for matching. Decision tree analysis and ROC curve-based methods of optimal cut-offs were used to improve clinical Nephrosclerosis criteria. RESULTS Nephrosclerosis prevalence was 2.7% in the general population, and eGFR decline and risk for kidney-related hospital admissions and ESKD were comparable to patients with diabetic kidney disease. In the biopsy cohort, current clinical criteria had very low sensitivity (0.13) but high specificity (0.94) for biopsy-verified arterioNephrosclerosis. A new optimized diagnostic algorithm based on proteinuria ( 155 mm Hg) and age (>75 years) only marginally improved diagnostic accuracy (sensitivity 0.19, specificity 0.96). Likewise, there were still false-positive cases with treatable diagnoses like glomerulonephritis, interstitial nephritis and others (40% of all test positive). Decision curve analysis showed that the new criteria can lead to higher clinical utility, especially for patients considering the potential harms to be close to the potential benefits, while the more risk-tolerant ones (harm:benefit ratio < 1:4) should consider kidney biopsy. CONCLUSION Further improvements of the current clinical criteria seem difficult, so risks and benefits of kidney biopsy could be more actively discussed with selected patients to reduce misclassification and direct treatment.
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Hypertensive Nephrosclerosis: wider kidney biopsy indications may be needed to improve diagnostics
Journal of internal medicine, 2020Co-Authors: Stein Hallan, Marius Altern Ovrehus, Rune Bjorneklett, Knut Aasarod, Agnes B. FogoAbstract:BACKGROUND Hypertensive Nephrosclerosis is the presumed underlying cause in many end-stage kidney disease (ESKD) patients, but the diagnosis is disputed and based on clinical criteria with low diagnostic accuracy. OBJECTIVE To evaluate and improve the diagnostic process for Nephrosclerosis patients. METHODS We included adults from the population-based HUNT study (n = 50 552), Norwegian CKD patients referred for kidney biopsy 1988-2012 (n = 7261), and unselected nephrology clinic patients (n = 193) used for matching. Decision tree analysis and ROC curve-based methods of optimal cut-offs were used to improve clinical Nephrosclerosis criteria. RESULTS Nephrosclerosis prevalence was 2.7% in the general population, and eGFR decline and risk for kidney-related hospital admissions and ESKD were comparable to patients with diabetic kidney disease. In the biopsy cohort, current clinical criteria had very low sensitivity (0.13) but high specificity (0.94) for biopsy-verified arterioNephrosclerosis. A new optimized diagnostic algorithm based on proteinuria ( 155 mm Hg) and age (>75 years) only marginally improved diagnostic accuracy (sensitivity 0.19, specificity 0.96). Likewise, there were still false-positive cases with treatable diagnoses like glomerulonephritis, interstitial nephritis and others (40% of all test positive). Decision curve analysis showed that the new criteria can lead to higher clinical utility, especially for patients considering the potential harms to be close to the potential benefits, while the more risk-tolerant ones (harm:benefit ratio
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Clinical Phenotypes and Long-term Prognosis in White Patients With Biopsy-Verified Hypertensive Nephrosclerosis.
Kidney international reports, 2019Co-Authors: Marius Altern Ovrehus, Agnes B. Fogo, Rune Bjorneklett, Knut Aasarod, Aydin Dadfar, Tine Simensen Oldereid, Stein HallanAbstract:Introduction Hypertensive Nephrosclerosis is considered the second most common cause of end-stage renal disease (ESRD), but it is still an insufficiently studied and controversial disease entity. More information on the phenotype and prognosis is needed to improve clinical diagnostics and treatment. Methods We included all Norwegian patients with chronic kidney disease (CKD) referred for kidney biopsy between 1988 and 2012 whose clinical presentation was consistent with, but not primarily suspicious for, hypertensive Nephrosclerosis (n = 4920); follow-up continued until 2013. Results A total of 918 patients (19%) had biopsy-verified hypertensive Nephrosclerosis (i.e., arterioNephrosclerosis). Their most common biopsy indications were proteinuria (57%), low estimated glomerular filtration rate (eGFR) (44%), hematuria (34%), or combinations of these indications. Multivariable logistic regression analysis revealed that arterioNephrosclerosis was significantly associated with higher age, male sex, not having diabetes, higher blood pressure, lower proteinuria, and not having hematuria (P 0.05 for all). The most common biopsy-verified diagnoses in patients fulfilling the clinical criteria for hypertensive Nephrosclerosis were arterioNephrosclerosis (40%), glomerulonephritis (22%), and interstitial nephritis (14%), reflecting that the criteria had low sensitivity (0.17) and high specificity (0.94). ESRD and mortality risks did not differ in patients with arterioNephrosclerosis compared to patients with glomerulonephritis, interstitial nephritis, or other relevant diagnoses (P > 0.1 for both), whereas patients with diabetic kidney disease had a 2-fold higher risk (P Conclusion ArterioNephrosclerosis is a high-risk disease, often with an atypical phenotype with proteinuria and hematuria contributing to low accuracy for current clinical criteria for hypertensive Nephrosclerosis.
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Gene Expression Studies and Targeted Metabolomics Reveal Disturbed Serine, Methionine, and Tyrosine Metabolism in Early Hypertensive Nephrosclerosis
Elsevier, 2019Co-Authors: Marius A. Øvrehus, Per Bruheim, Leila R. Zelnick, Knut A. Langlo, Kumar Sharma, Ian H. De Boer, Stein HallanAbstract:Introduction: Hypertensive Nephrosclerosis is among the leading causes of end-stage renal disease, but its pathophysiology is poorly understood. We wanted to explore early metabolic changes using gene expression and targeted metabolomics analysis. Methods: We analyzed gene expression in kidneys biopsied from 20 patients with Nephrosclerosis and 31 healthy controls with an Affymetrix array. Thirty-one amino acids were measured by liquid chromatography coupled with mass spectrometry (LC-MS) in urine samples from 62 patients with clinical hypertensive Nephrosclerosis and 33 age- and sex-matched healthy controls, and major findings were confirmed in an independent cohort of 45 cases and 15 controls. Results: Amino acid catabolism and synthesis were strongly underexpressed in hypertensive Nephrosclerosis (13- and 7-fold, respectively), and these patients also showed gene expression patterns indicating decreased fatty acid oxidation (12-fold) and increased interferon gamma (10-fold) and cellular defense response (8-fold). Metabolomics analysis revealed significant distribution differences in 11 amino acids in hypertensive Nephrosclerosis, among them tyrosine, phenylalanine, dopamine, homocysteine, and serine, with 30% to 70% lower urine excretion. These findings were replicated in the independent cohort. Integrated gene-metabolite pathway analysis showed perturbations of renal dopamine biosynthesis. There were also significant differences in homocysteine/methionine homeostasis and the serine pathway, which have strong influence on 1-carbon metabolism. Several of these disturbances could be interconnected through reduced regeneration of tetrahydrofolate and tetrahydrobiopterin. Conclusion: Early hypertensive Nephrosclerosis showed perturbations of intrarenal biosynthesis of dopamine, which regulates natriuresis and blood pressure. There were also disturbances in serine/glycine and methionine/homocysteine metabolism, which may contribute to endothelial dysfunction, atherosclerosis, and renal fibrosis. Keywords: amino acids, gene expression, hypertensive nephropathy, metabolomics, nephrosclerosi
Alain Meyrier - One of the best experts on this subject based on the ideXlab platform.
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Nephrosclerosis: A Term in Quest of a Disease
Nephron, 2015Co-Authors: Alain MeyrierAbstract:For a century, Nephrosclerosis was ascribed to nonmalignant hypertension and aging. However, it was intuitively perceived that hypertension may follow rather than explain this nephrovasculopathy. Hypertensive Nephrosclerosis was long considered a major cause of end-stage renal failure (ESRD). This is especially true in blacks of African descent but not in other ethnic populations. The term 'Nephrosclerosis' is still an easy way out to classify a patient with renal insufficiency. This leads to neglect the possibility of an overlooked nephropathy complicated by hypertension and to believe that drastic blood pressure control may retard the progression to ESRD. Several clinical and experimental lines of evidence lead to the understanding that Nephrosclerosis, especially in blacks, is a genetic renovasculopathy that precedes the rise in blood pressure. The identification of coding region variants in APOL1 encoding apolipoprotein L-1 in black but also white and Asians opens new lines of research on the genetics of nephroangiosclerosis and of FSGS. Metabolic derangements, such as obesity, oxidative stress, dyslipidemia and atherosclerosis may be considered confounding factors with regard to Nephrosclerosis. Histomorphometric studies led to sorting out the lesions due to aging from those stemming from hypertension. They shed new light not only on glomerular lesions that comprise ischemic obsolescence but also on glomerulomegaly and focal-segmental sclerosis, the latter due to a loss of renal autoregulation. It appears that the control of hypertension is not credited with the expected benefit for slowing the decline of renal function. 'Nephrosclerosis' can be considered an umbrella term of poor significance that should be replaced by its pathologic description, that is, arterioNephrosclerosis and incite to elucidate the various genetic and metabolic factors that lead to a lesion in quest of a specific disease.
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Nephrosclerosis: update on a centenarian
Nephrology dialysis transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2014Co-Authors: Alain MeyrierAbstract:Abstract Nephrosclerosis is an umbrella term defining changes in all compartments of the kidney, changes caused by hypertension and by ageing. Among other lesions, arteriolosclerosis and arteriolohyalinosis play a major role in inducing glomerular ischaemic shrinking and sclerosis along with glomerulomegaly and focal-segmental glomerulosclerosis (FSGS). These lesions are accompanied by tubulointerstitial inflammation and fibrosis that predict the decline of renal function. Nephrosclerosis is a major cause of renal insufficiency in blacks of African descent with a severe, early form of renovasculopathy and a rapid course to renal failure with predominant lesions of FSGS. It seems that in blacks, separate genetic factors independently lead to vascular lesions and to hypertension with a different time-scale of their onset and of their progression, nephroangiosclerosis preceding the onset of hypertension. Conversely, true and histologically identified Nephrosclerosis in white Europeans rarely leads to end-stage renal disease in the absence of malignant hypertension. Various animal models demonstrate that renal vascular lesions may exist in the absence of hypertension. These experiments also point to a major role of angiotensin II and of a number of independent and overlapping cellular and molecular pathways in a cascade of inflammatory events that end in renal fibrosis. Two pathophysiologic mechanisms are at work in inducing glomerular lesions and tubulointerstitial fibrosis: a loss of autoregulation of the renal blood flow caused by an arteriolohyalinosis of the glomerular afferent arteriole and ischaemia that fosters the generation of hypoxia inducible-fibrosing factors. Not all antihypertensive drugs equally protect the kidney from Nephrosclerosis. Angiotensin II antagonists exert a favourable effect on hyperfiltration. Conversely, dihydropyridine calcium-channel blockers and vasodilators do not withstand the derangement of renal autoregulation.
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Hypertensive Nephrosclerosis pathogenesis, diagnosis and management.
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation Saudi Arabia, 1999Co-Authors: Alain MeyrierAbstract:Nephrovasculopathies are an increasing cause of end-stage renal failure. Hypertensive nephroscierosis is an old concept. In fact, the renal vascular lesions corresponding to this term can result from aging or a host of parenchymal renal diseases in the absence of elevated blood pressure. Nephrosclerosis is overdiagnosed. The diagnosis should rest only on renal biopsy, which is not usually done in an elderly patient with chronic renal insufficiency, hypertension and atrophic kidneys. Atherosclerotic renal disease and renal cholesterol crystal embolism are often misdiagnosed for nephro-sclerosis. The classical picture of Nephrosclerosis is the patient with primary hypertension accompanied by arterio-and arterioloNephrosclerosis, focal and segmental glomerulosclerosis leading to glomerular obsolescence, interstitial fibrosis and inflammatory infiltrates. However, similar lesions can be observed in animal models as well as in some humans, especially blacks, in the absence of, or preceding the onset of hypertension. This suggests that Nephrosclerosis might stem from a genetic defect in the renal vascular bed, a defect closely associated with the hypertensive trait. Recent data regarding the link between low birthweight and hypertension of early onset might have bearing on future developments in understanding the pathogenesis of Nephrosclerosis. Treatment pursues two goals: normalizing blood pressure according to international recommendations and retarding sclerosis with a regimen essentially based on angiotensin II antagonists.
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Renal vascular lesions in the elderly: Nephrosclerosis or atheromatous renal disease?
Nephrology Dialysis Transplantation, 1996Co-Authors: Alain MeyrierAbstract:In white Europeans, renal size and function decline with age. This phenomenon has long been attributed to Nephrosclerosis, i.e. primary vascular lesions associated with glomerular obsolescence, tubulointerstitial lesions and fibrosis. The part played by ageing and by pre-existing hypertension is still a matter of debate. Nephrosclerosis is a diagnosis of exclusion when no renal histology is available. As renal biopsy is rarely carried out in an elderly patient with atrophic kidneys, a long history of hypertension and only microalbuminuria or no proteinuria, the diagnosis of Nephrosclerosis is generally overestimated. Even when renal histology is available, only subtle differences in vascular lesions have been claimed to distinguish those due to ageing from those due to hypertension. At any rate, meticulous control of blood pressure is certainly the most efficient means of protecting the renal vessels from further deterioration. Atheromatous renal disease has more recently been recognized as a major cause of progressive renal failure in the elderly. Renal artery stenoses due to atheromatous plaques might well be the cause of 10-15% of end-stage renal failure in whites aged >50 and be the fourth cause of uraemia in this age group. Such stenoses are usually bilateral and developing. Present imaging methods, such as duplex ultrasound scanning and renal scintigraphy, are valuable means of diagnosis. Renal angioplasty can halt the the pace of renal insufficiency, or even durably improve it in nearly half of the cases, Finally, aorto-renal atheroma is a common and underestimeted cause of cholesterol embolism. Minor, spontaneous forms thereof are indistinguishable from Nephrosclerosis. Massive embolism entails a dismal prognosis, in terms of both renal function and patient survival. In conclusion, renal vascualr lesions in the elderly remain a major concern. Improving non-invasive diagnostic procedures and applying preventative as well as curative measures should significantly reduce the incidence of end-stage renal disease is such patients.
Makoto Ogura - One of the best experts on this subject based on the ideXlab platform.
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Volume Ratio of Glomerular Tufts to Bowman Capsules and Renal Outcomes in Nephrosclerosis
American Journal of Hypertension, 2019Co-Authors: Kotaro Haruhara, Nobuo Tsuboi, Takaya Sasaki, Hoichi Amano, Mai Tanaka, Kentaro Koike, Go Kanzaki, Yusuke Okabayashi, Yoichi Miyazaki, Makoto OguraAbstract:The concomitant appearance of glomerular collapse and enlargement is characteristic of the histological findings in Nephrosclerosis. However, no previous study quantitatively examined the clinicopathological significance of this feature in patients with biopsy-proven Nephrosclerosis. Renal biopsy specimens and follow-up data from Nephrosclerosis patients with estimated glomerular filtration rates >30 ml/min/1.73 m2 at diagnosis were retrospectively reviewed. Mean volumes for glomerular tufts (GV) and Bowman capsules (BV) were separately calculated, based on the measurement of all areas of glomerular tufts and Bowman capsules in a cross-section of biopsy specimens. The G/B ratio was defined as the ratio of GV to BV. The doubling of serum creatinine levels (DSC) and the initiation of renal replacement therapies (end-stage renal disease (ESRD)) were examined as renal outcome indices. A total of 67 patients with biopsy-proven Nephrosclerosis were included. Clinicopathological findings at biopsy, other than GV, were comparable among all patients, irrespective of G/B ratio. Overall, 25 patients (37%) developed DSC and 9 (13%) developed ESRD during the median observation periods of 7.8 and 8.5 years, respectively. Renal survival curve analyses indicated a significantly worse prognosis for patients with a low G/B ratio, as compared with those with a high G/B ratio. Cox hazard analyses for DSC identified low G/B ratio as a significant predictor, but not low GV or BV. These results suggest that the quantitative evaluation of G/B ratio may detect subtle abnormalities in the glomerulus, indicating the subsequent renal outcomes of Nephrosclerosis patients.
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Volume Ratio of Glomerular Tufts to Bowman Capsules and Renal Outcomes in Nephrosclerosis.
American journal of hypertension, 2018Co-Authors: Kotaro Haruhara, Nobuo Tsuboi, Takaya Sasaki, Hoichi Amano, Mai Tanaka, Kentaro Koike, Go Kanzaki, Yusuke Okabayashi, Yoichi Miyazaki, Makoto OguraAbstract:Background The concomitant appearance of glomerular collapse and enlargement is characteristic of the histological findings in Nephrosclerosis. However, no previous study quantitatively examined the clinicopathological significance of this feature in patients with biopsy-proven Nephrosclerosis. Methods Renal biopsy specimens and follow-up data from Nephrosclerosis patients with estimated glomerular filtration rates >30 ml/min/1.73 m2 at diagnosis were retrospectively reviewed. Mean volumes for glomerular tufts (GV) and Bowman capsules (BV) were separately calculated, based on the measurement of all areas of glomerular tufts and Bowman capsules in a cross-section of biopsy specimens. The G/B ratio was defined as the ratio of GV to BV. The doubling of serum creatinine levels (DSC) and the initiation of renal replacement therapies (end-stage renal disease (ESRD)) were examined as renal outcome indices. Results A total of 67 patients with biopsy-proven Nephrosclerosis were included. Clinicopathological findings at biopsy, other than GV, were comparable among all patients, irrespective of G/B ratio. Overall, 25 patients (37%) developed DSC and 9 (13%) developed ESRD during the median observation periods of 7.8 and 8.5 years, respectively. Renal survival curve analyses indicated a significantly worse prognosis for patients with a low G/B ratio, as compared with those with a high G/B ratio. Cox hazard analyses for DSC identified low G/B ratio as a significant predictor, but not low GV or BV. Conclusions These results suggest that the quantitative evaluation of G/B ratio may detect subtle abnormalities in the glomerulus, indicating the subsequent renal outcomes of Nephrosclerosis patients.
Adalbert Bohle - One of the best experts on this subject based on the ideXlab platform.
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Renal morphology in essential hypertension: Analysis of 1177 unselected cases
Kidney International, 1998Co-Authors: Adalbert Bohle, A Greschniok, Manfred Wehrmann, R JunghansAbstract:Renal morphology in essential hypertension: Analysis of 1177 unselected cases. Morphological and clinical analysis of 1177 renal biopsies from nonselected patients with essential hypertension revealed compensated benign Nephrosclerosis in 775 cases. Decompensated benign Nephrosclerosis was found in 251 cases, and secondary malignant Nephrosclerosis was found in 151 cases. This article describes the morphological and clinical features of decompensated benign Nephrosclerosis, which has received little recognition until now. The morphological and clinical features of secondary malignant Nephrosclerosis, which is induced by hypertension, are also considered. There is also a discussion of the differentiation of the latter from primary malignant Nephrosclerosis, in which stenosis of the preglomerular vessels develops in the presence of normal blood pressure and leads secondarily to renal hypertension.
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Renal morphology in essential hypertension: analysis of 1177 unselected cases.
Kidney international. Supplement, 1998Co-Authors: Adalbert Bohle, A Greschniok, Manfred Wehrmann, R JunghansAbstract:Morphological and clinical analysis of 1177 renal biopsies from nonselected patients with essential hypertension revealed compensated benign Nephrosclerosis in 775 cases. Decompensated benign Nephrosclerosis was found in 251 cases, and secondary malignant Nephrosclerosis was found in 151 cases. This article describes the morphological and clinical features of decompensated benign Nephrosclerosis, which has received little recognition until now. The morphological and clinical features of secondary malignant Nephrosclerosis, which is induced by hypertension, are also considered. There is also a discussion of the differentiation of the latter from primary malignant Nephrosclerosis, in which stenosis of the preglomerular vessels develops in the presence of normal blood pressure and leads secondarily to renal hypertension.
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The pathogenesis of chronic renal insufficiency in renal vasculopathies.
Polskie Archiwum Medycyny Wewnetrznej-polish Archives of Internal Medicine, 1994Co-Authors: Adalbert Bohle, S. Mackensen-haen, Manfred Wehrmann, T.-c. XiaoAbstract:Comparative clinical and morphological investigations on the pathogenesis of chronic renal insufficiency in various types of renal vasculopathy revealed the following: 1) Compensated benign Nephrosclerosis, with hyalinosis of the walls of the afferent vessels, does not lead to renal insufficiency, since relatively few glomeruli, mostly subcapsular, become obliterated in this disease. 2) In decompensated benign Nephrosclerosis, in which not only the afferent vessels but also the glomeruli and the cortical interstitium are involved, there is a significant positive correlation between the relative width of the renal cortical interstitium and the serum creatinine concentration and a significant negative correlation between the relative volume of the postglomerular capillaries and the serum creatinine concentration, as in the primary glomerulopathies. 3) In primary malignant Nephrosclerosis, which is always accompanied by haemolytic-uraemic syndrome, the relative width of the cortical interstitium is not related to the serum creatinine concentration. Chronic renal insufficiency develops in this disease as a result of a fall in glomerular filtration rate to inadequate levels due to impairment of renal perfusion by stenotic changes in the preglomerular vessels. 4) In secondary malignant Nephrosclerosis, which is never accompanied by haemolytic-uraemic syndrome, there is, as in the primary glomerulopathies, a significant positive correlation between the relative width of the renal cortical interstitium and the serum creatinine concentration and a significant negative correlation between the relative capillary volume and the serum creatinine concentration. 5) In decompensated benign Nephrosclerosis the severity of the renal insufficiency depends largely on the degree of obliteration of the postglomerular capillaries.(ABSTRACT TRUNCATED AT 250 WORDS)
