P60 HISTOPATHOLOGICAL DIAGNOSES IN PATIENTS

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P60
HISTOPATHOLOGICAL DIAGNOSES
HYPERTENSIVE KIDNEY DISEASE
IN
PATIENTS
PRESENTING
WITH
Joslin JR, Yalamarti T, Wood SJ, Suckling RJ, Swift PA
Department of Renal Medicine, Epsom and St Helier University Hospitals NHS Trust, UK
Background
Hypertension is a recognized cause of acute and chronic kidney disease (CKD). It is also a
common complication of CKD from any aetiology. The underlying histopathological diagnoses
have not been well described in patients who present with a clinical diagnosis of hypertensive
kidney disease.
Methods
We have conducted an observational study of consecutive renal biopsies performed over a 5year period, in patients with a clinical diagnosis of hypertensive nephropathy (HN). Clinical
diagnosis of HN was determined from case notes and was agreed independently by two
nephrologists. Outcomes were the histological presence of HN, glomerulonephritis (GN) or
other kidney disease, and potential clinical predictors of HN.
Results
 53 native renal biopsies were performed in patients with a clinical diagnosis of
hypertensive kidney disease. Mean age was 49 years; 41 were male, and mean estimated
Glomerular Filtration Rate (eGFR) was 23 mls/min/1.73m2.
Probable Underlying Diagnosis Based on Histological Findings
Hypertensive nephropathy
Glomerulonephritis
IgA nephropathy
FSGS
Diabetic nephropathy
Microangiopathic process / HUS
Inadequate tissue
Chronic damage, no specific etiological features
Cases
29
16
10
6
1
1
2
4
 18/53 (34%) had a documented urinary protein-creatinine ratio (uPCR) >300mg/mmol.
This cohort were equally as likely to those with uPCR <300mg/mmol to have a nonhypertensive histological diagnosis (p=0.512).
 37/53 (70%) had documented haematuria > 1+ on dipstick. 16/37 (43%) of this cohort had
a non-hypertensive histopathological diagnosis, compared to only 1/11 (9%) of those with
1+ or less haematuria on dipstick, suggesting that the presence of haematuria may make a
non-HN diagnosis more likely (p=0.0697).
 11/53 (21%) presented with accelerated hypertension. On biopsy 6/11 (55%) had
confirmed HN and 5/11 (45%) had GN (2 IgA nephropathy, 3 FSGS).
 45/53 (85%) had no post-procedure complications. 5/53 (9%) patients had minor bleeds,
and 1/53 (2%) had a major bleed requiring renal arterial embolisation. 2 of the
complications (1 major, 1 minor) were in patients with accelerated hypertension.
Conclusions
Native renal biopsies performed in patients with a clinical diagnosis of hypertensive kidney
disease showed histological evidence of HN as the primary diagnosis in only 55% of cases.
Similar results were seen in the small sub-group who presented with accelerated hypertension,
in whom the procedural complication appeared to be higher. Urinalysis and quantification of
proteinuria did not predict histological diagnosis. Kidney biopsy should be considered in
individuals who present with hypertension and kidney damage.
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