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Nationwide multicenter kidney biopsy study of Japanese patients with hypertensive nephrosclerosis



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.


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.


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).


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.

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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.

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Correspondence to Takashi Wada.

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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.

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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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Furuichi, K., Shimizu, M., Yuzawa, Y. et al. Nationwide multicenter kidney biopsy study of Japanese patients with hypertensive nephrosclerosis. Clin Exp Nephrol 22, 629–637 (2018).

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  • Nephrosclerosis
  • Kidney biopsy
  • CKD heat map
  • Hypertension