Objective: The prevalence of chronic kidney disease(CKD) is higher among hypertensive patients than in the general population. In clinical practice, hypertensive nephropathy(HNP) is often diagnosed by exclusion, based solely on reduced glomerular filtration rate(GFR) and/or proteinuria/albuminuria. To assess the prevalence of histopathological lesions characteristic of hypertension in renal biopsies from patients with documented hypertension. Design and method: We retrospectively analyzed patients who underwent renal biopsy between January 1, 2023, and February28, 2025, at the Hypertension–Nephrology Center, Department of Internal Medicine, University of Szeged. The prevalence of hypertension and hypertension-mediated target organ damage was evaluated. Results: Medical records of 129 biopsied patients were reviewed (68females, 61males; mean age 57.8 years; mean BMI 28.8 kg/m2). Documented hypertension was present in 108 cases (53females, 55males; mean age 59.6years 25–80; meanBMI 29.4 kg/m2 19–50), with a mean of 3.2 antihypertensive medications per patient. Histopathological features consistent with HNP were identified in 53 cases, most frequently in association with IgA nephropathy(n = 18); signs of accelerated hypertension were observed in 3 cases. In patients with HNP characteristics, the mean duration of hypertension was nearly twice as long as in hypertensive patients without histopathological renal alterations(12.4 vs. 6.8years). Hypertensive retinopathy of any stage was present in 31 cases. Left ventricular hypertrophy was documented in 38 cases and not reported in 10. The mean renal resistive index(RI) was 69.8 ± 10.1%. Mean eGFR was 36.7 ± 23.8 mL/min/1.73 m2 and mean urinary protein-to-creatinine ratio(PCR) was 433.2 ± 381.8 mg/mmol. Among hypertensive patients without histopathological renal lesions, hypertensive angiopathy was present in 25 of 55 cases and absent in 13. Left ventricular hypertrophy was present in 33 and excluded in 16 patients. MeanRI was 74.8 ± 10.7%, mean eGFR 39.3 ± 26.0 mL/min/1.73 m2, and meanPCR 484.2 ± 413.3 mg/mmol. Conclusions: Hypertensive patients with histopathological features of HNP show a higher prevalence of additional hypertension-mediated target organ damage. However, reduced eGFR and/or proteinuria alone in hypertensive patients does not necessarily indicate HNP as the cause of CKD. Epidemiological data based solely on ICD codes should therefore be interpreted with caution in the absence of histopathological confirmation.
Fejes et al. (Fri,) studied this question.