Vikse et al identified factors predictive of progression to end-stage renal disease (ESRD) in a patient with benign nephrosclerosis. These can help to identify a patient who may benefit from more aggressive management. The authors are from the Norwegian Kidney Register, Haukeland University Hospital, and University Hospital of Trondheim.
Patient selection: benign hypertension with biopsy-proven nephrosclerosis
Parameters associated with short-term progression (3 year survival):
(1) serum creatinine in µmol/L
(2) systolic blood pressure in mm Hg
(3) urine protein in g per 24 hours
(4) age
(5) serum albumin
|
Parameter
|
Finding
|
Points
|
|
serum creatinine
|
< 200 µmol/L
|
0
|
|
|
>= 200 µmol/L
|
1
|
|
systolic blood pressure
|
< 160 mm Hg
|
0
|
|
|
>= 160 mm Hg
|
1
|
|
urine protein
|
< 1 g in 24 hours
|
0
|
|
|
>= 1 g in 24 hours
|
1
|
|
age
|
< 60 years of age
|
0
|
|
|
>= 60 years of age
|
1
|
|
serum albumin
|
>= 35 g/L
|
0
|
|
|
< 35 g/L
|
1
|
total number of risk factors for short-term progression to ESRD =
= SUM(points for all 5 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 5
• The risk for progression increases with the number of risk factors present.
• Long-term progression was associated with serum creatinine and the level of proteinuria.
• Increased mortality was associated with older age and higher serum creatinine.
Limitation:
• The population would be limited Northern Europeans.
• Blacks may show progression at lower levels of proteinuria.
• An elevated serum creatinine may be a manifestation of ESRD rather than a predictive factor.
