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Clinical and Experimental Nephrology

, Volume 22, Issue 3, pp 629–637 | Cite as

Nationwide multicenter kidney biopsy study of Japanese patients with hypertensive nephrosclerosis

  • Kengo Furuichi
  • Miho Shimizu
  • Yukio Yuzawa
  • Akinori Hara
  • Tadashi Toyama
  • Hiroshi Kitamura
  • Yoshiki Suzuki
  • Hiroshi Sato
  • Noriko Uesugi
  • Yoshifumi Ubara
  • Junichi Hoshino
  • Satoshi Hisano
  • Yoshihiko Ueda
  • Shinichi Nishi
  • Hitoshi Yokoyama
  • Tomoya Nishino
  • Kentaro Kohagura
  • Daisuke Ogawa
  • Koki Mise
  • Yugo Shibagaki
  • Kenjiro Kimura
  • Masakazu Haneda
  • Hirofumi Makino
  • Seiichi Matsuo
  • Takashi Wada
  • Research Group of Diabetic Nephropathy and Nephrosclerosis, Ministry of Health, Labour and Welfare of Japan, and Japan Agency for Medical Research and Development
Original article

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.

Keywords

Nephrosclerosis Kidney biopsy CKD heat map Hypertension 

Notes

Acknowledgements

This study was supported in part by a Grant-in-Aid for Diabetic Nephropathy and Nephrosclerosis Research from the Ministry of Health, Labour and Welfare of Japan and Grant-in-Aid for Practical Research Project for Renal Diseases, from the Japan Agency for Medical Research and Development (No. 15ek0310003h0001). This work was also supported in part by Grants-in-Aids from the Ministry of Education, Culture, Sports, Science, and Technology of the Japanese Government.

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (the medical ethics committee of Kanazawa University, Approval No. 1204)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Financial disclosure

All authors; none.

Supplementary material

10157_2017_1496_MOESM1_ESM.ppt (2.8 mb)
Supplementary Figure. Survival curves for each outcome as derived from the Kaplan–Meier method with log-rank test. Survival curves for the following: (A) composite kidney end points, (B) kidney death, (C) cardiovascular events, and (D) all-cause mortalities. Classification of three categories (Green & Yellow, Orange, and Red) is shown for all end points. The green line indicates Green & Yellow, the orange line indicates Orange, and the red line indicates Red. Differences between groups were compared using a log-rank test. (PPT 2869 kb)

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Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Kengo Furuichi
    • 1
  • Miho Shimizu
    • 1
  • Yukio Yuzawa
    • 2
  • Akinori Hara
    • 1
  • Tadashi Toyama
    • 1
  • Hiroshi Kitamura
    • 3
  • Yoshiki Suzuki
    • 4
  • Hiroshi Sato
    • 5
  • Noriko Uesugi
    • 6
  • Yoshifumi Ubara
    • 7
  • Junichi Hoshino
    • 7
  • Satoshi Hisano
    • 8
  • Yoshihiko Ueda
    • 9
  • Shinichi Nishi
    • 10
  • Hitoshi Yokoyama
    • 11
  • Tomoya Nishino
    • 12
  • Kentaro Kohagura
    • 13
  • Daisuke Ogawa
    • 14
  • Koki Mise
    • 14
  • Yugo Shibagaki
    • 15
  • Kenjiro Kimura
    • 16
  • Masakazu Haneda
    • 17
  • Hirofumi Makino
    • 14
  • Seiichi Matsuo
    • 18
  • Takashi Wada
    • 19
  • Research Group of Diabetic Nephropathy and Nephrosclerosis, Ministry of Health, Labour and Welfare of Japan, and Japan Agency for Medical Research and Development
  1. 1.Division of NephrologyKanazawa University HospitalKanazawaJapan
  2. 2.Department of NephrologyFujita Health University HospitalToyoakeJapan
  3. 3.Department of Pathology, Clinical Research CenterNational Hospital Organization Chiba East National HospitalChibaJapan
  4. 4.Health Administration CenterNiigata UniversityNiigataJapan
  5. 5.Clinical Pharmacology and TherapeuticsTohoku University Graduate School of Pharmaceutical SciencesSendaiJapan
  6. 6.Department of Pathology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  7. 7.Nephrology Center, Toranomon HospitalTokyoJapan
  8. 8.Department of Pathology, Faculty of MedicineFukuoka UniversityFukuokaJapan
  9. 9.Department of PathologyDokkyo Medical University Koshigaya HospitalKoshigayaJapan
  10. 10.Division of Nephrology and Kidney CenterKobe University Graduate School of MedicineKobeJapan
  11. 11.Department of NephrologyKanazawa Medical University School of MedicineUchinadaJapan
  12. 12.Second Department of Internal MedicineNagasaki University School of MedicineNagasakiJapan
  13. 13.Department of Cardiovascular Medicine, Nephrology and NeurologyUniversity of the Ryukyus School of MedicineOkinawaJapan
  14. 14.Department of Nephrology, Rheumatology, Endocrinology and MetabolismOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  15. 15.Division of Nephrology and Hypertension, Department of Internal MedicineSt. Marianna University School of MedicineYokohamaJapan
  16. 16.Tokyo Takanawa HospitalTokyoJapan
  17. 17.Division of Metabolism and Biosystemic Science, Department of MedicineAsahikawa Medical UniversityAsahikawaJapan
  18. 18.Division of Nephrology, Department of Internal MedicineNagoya University Graduate School of MedicineNagoyaJapan
  19. 19.Department of Nephrology and Laboratory MedicineKanazawa UniversityKanazawaJapan

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