Abstract

The occurrence of nephrotic range proteinuria in a non-diabetic hypertensive patient [Pt] is still considered by renal physicians to indicate the presence of an underlying primary renal disease eventhough case reports have noted marked proteinuria in some Pts with essential hypertension [EH] . The frequency of this association is unknown . We retrospectively reviewed our renal biopsy reports over an 8 yr period (1993-2000) and identified 237 non-diabetic Pts with laboratory documentation of proteinuria > 3.5g/d . After exclusion of Pts with serologic markers for lupus, biopsies showing either glomerular eosinophilic hyalinosis, positive immunofluorescence staining or dense deposits on electron microscopy, 13 of 237 (5.5%) cases satisfied the standard histologic criteria for hypertensive nephrosclerosis [HN] . All Pts were African Americans [AA] (Mean age 47.5 yrs) . The average mean arterial pressure was 122 mmHg, while urinary protein excretion ranged from 3.6 g/d to 18 g/d (mean 8.9 g/d) . The mean serum creatinine, albumin and cholesterol levels were 3.3 mg/dl, 3.1 g/dl and 245 mg/dl respectively . Optimal blood pressure control required 2 to 5 (mean 3) antihypertensive agents.

Nephrotic Syndrome [NS] may be more common in poorly controlled EH with HN than previously realized . In AA Pts, the differential diagnosis of NS should include HN .

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