Kengo Furuichi1, Miho Shimizu1, Yukio Yuzawa2, Akinori Hara1, Tadashi Toyama1, Hiroshi Kitamura3, Yoshiki Suzuki4, Hiroshi Sato5, Noriko Uesugi6, Yoshifumi Ubara7, Junichi Hoshino7, Satoshi Hisano8, Yoshihiko Ueda9, Shinichi Nishi10, Hitoshi Yokoyama11, Tomoya Nishino12, Kentaro Kohagura13, Daisuke Ogawa14, Koki Mise14, Yugo Shibagaki15, Kenjiro Kimura16, Masakazu Haneda17, Hirofumi Makino14, Seiichi Matsuo18, Takashi Wada19. 1. Division of Nephrology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan. 2. Department of Nephrology, Fujita Health University Hospital, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. 3. Department of Pathology, Clinical Research Center, National Hospital Organization Chiba East National Hospital, 673 Nitona, Chiba, Chiba, 260-8712, Japan. 4. Health Administration Center, Niigata University, 2-8085 Igarashi, Nishi-ku, Niigata, Niigata, 950-2181, Japan. 5. Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences, 6-3 Aoba, Aramaki, Aoba-ku, Sendai, 980-8578, Japan. 6. Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. 7. Nephrology Center, Toranomon Hospital, 2-2-2 Toranomon, Minato, Tokyo, 105-8470, Japan. 8. Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 9. Department of Pathology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan. 10. Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. 11. Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan. 12. Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. 13. Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus School of Medicine, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan. 14. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan. 15. Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Yokohama, Kanagawa, 216-8511, Japan. 16. Tokyo Takanawa Hospital, 3-10-11 Takanawa, Minato-ku, Tokyo, 108-8606, Japan. 17. Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, 1-1-1 Higashi-Nijyo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan. 18. Division of Nephrology, Department of Internal Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. 19. Department of Nephrology and Laboratory Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan. twada@m-kanazawa.jp.
Abstract
BACKGROUND: Nephrosclerosis is an increasingly reason for dialysis in Japan. However, kidney biopsy specimens for hypertensive nephrosclerosis are very limited; thus, the pathologic evaluation of hypertensive nephrosclerosis currently remains unclear. 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.
BACKGROUND:Nephrosclerosis is an increasingly reason for dialysis in Japan. However, kidney biopsy specimens for hypertensive nephrosclerosis are very limited; thus, the pathologic evaluation of hypertensive nephrosclerosis currently remains unclear. METHODS: Clinical and pathologic data of a total of 184 biopsy-confirmed hypertensive nephrosclerosispatients 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.
Authors: Lawrence J Appel; Jackson T Wright; Tom Greene; Lawrence Y Agodoa; Brad C Astor; George L Bakris; William H Cleveland; Jeanne Charleston; Gabriel Contreras; Marquetta L Faulkner; Francis B Gabbai; Jennifer J Gassman; Lee A Hebert; Kenneth A Jamerson; Joel D Kopple; John W Kusek; James P Lash; Janice P Lea; Julia B Lewis; Michael S Lipkowitz; Shaul G Massry; Edgar R Miller; Keith Norris; Robert A Phillips; Velvie A Pogue; Otelio S Randall; Stephen G Rostand; Miroslaw J Smogorzewski; Robert D Toto; Xuelei Wang Journal: N Engl J Med Date: 2010-09-02 Impact factor: 91.245
Authors: Lawrence J Appel; Jackson T Wright; Tom Greene; John W Kusek; Julia B Lewis; Xuelei Wang; Michael S Lipkowitz; Keith C Norris; George L Bakris; Mahboob Rahman; Gabriel Contreras; Stephen G Rostand; Joel D Kopple; Francis B Gabbai; Gerald I Schulman; Jennifer J Gassman; Jeanne Charleston; Lawrence Y Agodoa Journal: Arch Intern Med Date: 2008-04-28