Hypertensive nephropathy is the second most common cause for starting renal replacement therapy in Spain with a steady incidence since 1997. Data on incidence of hypertensive nephropathy previously to dialysis are scanty because there are not registries similar to those used for renal replacement therapy. Retrospectively we studied the records of our hospital Nephrology outpatients clinic from January, 1991 to December, 2007. Diagnosis was commonly made using clinical criteria in most of cases. There were 60 cases with proteinuria higher than 1 g/day and so that renal biopsies were performed. During this time 479 (44.0 pmp) patients were diagnosed of hypertensive nephropathy (mean age 66.6 +/- 12.1 years and 43.0% were women). Incidence increased from 33.3 pmp (1991) to 76.2 pmp (2006). There was a steady trend to increase incidence since 16.7 pmp in 1991 up to 89.5 pmp in 2007. Mean incidence was 31.8 pmp between 1991 and 1995, 32.1 pmp in the period 1996-2000; and 54.4 pmp from 2001 to 2006. The mean age of incident patients showed a J curve. 53 subjects (11.6%) have started renal replacement therapy. Survival before starting renal replacement therapy was 96.0 at first year, 85.9% at five years and 81.6% after seven years of follow-up. Incidence of hypertensive nephropathy seems to have increased last years specially in spite of therapeutic improvements the prognosis is still unfavourable. Less restricted age criteria for submitting patients may have influenced these results.