Abstract
BackgroundPatients with nephrosclerosis display heterogenous clinical phenotypes, often leading to a clinical diagnosis discordant with pathological nephrosclerosis diagnosis. However, little is known about clinical factors associated with clinicopathological discordance of biopsy-proven nephrosclerosis.MethodsIn a cross-sectional study of 891 patients with biopsy-proven nephrosclerosis registered in the Japan Renal Biopsy Registry (J-RBR) between July 2007 and June 2016, we examined clinical characteristics associated with a pre-biopsy clinical diagnosis discordant with pathological nephrosclerosis diagnosis using multivariable logistic regression with adjustment for relevant clinical characteristics.ResultsOverall, the mean (SD) age was 58.6 (13.7) years; 67.6% of patients were male; and 63.2% were on antihypertensive drugs. The median estimated glomerular filtration rate (eGFR) was 43.8 mL/min/1.73 m2 and the median proteinuria was 0.5 g/day. Of the 891 patients, 497 (55.8%) had a clinical diagnosis discordant with pathological nephrosclerosis diagnosis, with chronic nephritic syndrome being the most common (> 75%) discordant clinical diagnosis. After multivariable adjustment, age (odds ratio 1.34, [95% confidence interval, 1.16–1.55], per 10 years increase), eGFR (1.10 [1.00–1.21], per 10 mL/min/1.73 m2 increase), and proteinuria (1.20 [1.03–2.16], per 1 g/day decrease) were found to be significantly associated with the clinicopathological discordance.ConclusionsPatients with older age, higher eGFR, and lower proteinuria had significantly higher likelihood of being clinically diagnosed with other glomerular disease in patients with biopsy-proven nephrosclerosis. Our findings highlight the heterogeneous clinical phenotypes of nephrosclerosis and suggest the need for continuous improvement of clinical diagnostic accuracy as well as for wider kidney biopsy indications for nephrosclerosis.
Highlights
MethodsNephrosclerosis is one of the leading causes of endstage renal disease (ESRD), accounting for ~ 15% of all incident ESRD cases in Japan and even higher (~ 28%) in the United States, and these numbers have been steadily increasing along with the increasing prevalence of hypertension across the world [1, 2]
In the present study, using a unique and large nationwide multicenter renal biopsy registry in Japan, where pre-biopsy clinical diagnoses are available, we aimed to identify clinical factors associated with a clinical diagnosis discordant with pathological nephrosclerosis diagnosis in patients with biopsy-proven nephrosclerosis
Among 31,409 patients with biopsyproven renal disease who were registered in the Japan Renal Biopsy Registry (J-RBR) between July 2007 and June 2016, we identified 1068 patients who had a pathological diagnosis of hypertensive nephrosclerosis and either nephrosclerosis or sclerosing glomerulonephritis, irrespective of their clinical diagnosis
Summary
Nephrosclerosis is one of the leading causes of endstage renal disease (ESRD), accounting for ~ 15% of all incident ESRD cases in Japan and even higher (~ 28%) in the United States, and these numbers have been steadily increasing along with the increasing prevalence of hypertension across the world [1, 2] Despite this fact, the diagnosis of nephrosclerosis is often one of exclusion and typically based on clinical manifestations, such as long-standing hypertension, the absence of diabetes, hematuria, and overt proteinuria, and the absence of other known CKD causes [3]; and the diagnostic accuracy of nephrosclerosis has long been questioned, as reflected by the wide range of reported incidence of ESRD due to nephrosclerosis across studies [3]. Our findings highlight the heterogeneous clinical phenotypes of nephrosclerosis and suggest the need for continuous improvement of clinical diagnostic accuracy as well as for wider kidney biopsy indications for nephrosclerosis
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