Objective: Arterial hypertension (AH) is a major contributor to chronic kidney disease progression, frequently leading to nephrosclerosis and other histopathological changes visible on kidney biopsy. However, the specific impact of a pre-existing AH diagnosis on biopsy findings and renal function parameters remains incompletely characterized in real-world biopsy cohorts in patients with IgA nephropathy. We aimed to evaluate whether the presence of an AH diagnosis at the time of kidney biopsy is independently associated with key histopathological features (assessed by the MEST score components) and renal function (serum creatinine level), while controlling for age and sex in patients with IgA nephropathy. Design and method: We analyzed data from 201 patient who underwent kidney biopsy and had IgA nephropathy as a pathological diagnosis. The primary exposure variable was the presence of an AH diagnosis at biopsy. Other evaluated parameters included age, sex, individual MEST score components (mesangial hypercellularity M, endocapillary hypercellularity E, segmental glomerulosclerosis S, tubular atrophy/interstitial fibrosis T), and serum creatinine dichotomized as >120 μmol/L or less/equal 120 μmol/L. Associations were assessed using multivariable logistic regression for the binary/categorical histopathological features and dichotomized serum creatinine, while controlling for age and sex. Results: The presence of AH diagnosis at the time of biopsy showed a significant association with more severe histopathological changes, particularly higher scores in the MEST classification components indicative of chronic damage (notably S and T scores), independent of age. Patients with AH diagnosis also demonstrated significantly higher proportion of serum creatinine >120 μmol/L compared to those without AH diagnosis, independent of age and sex. Age and male sex were positively correlated with chronic histological damage as well. Conclusions: These findings indicate that a documented diagnosis of arterial hypertension at the time of kidney biopsy is strongly linked to more advanced chronic histopathological changes (especially segmental glomerulosclerosis and tubulointerstitial fibrosis) and worse renal function (elevated serum creatinine) in patients with IgA nephropathy. This supports the important role of AH as a driver of renal parenchymal injury and highlights the need for intensive blood pressure control in patients at risk of kidney disease progression.
Miglinas et al. (Fri,) studied this question.