Journal Article

Long-term renal survival in malignant hypertension

Roberto González, Enrique Morales, Julian Segura, Luis M. Ruilope and Manuel Praga

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 25, issue 10, pages 3266-3272
Published in print October 2010 | ISSN: 0931-0509
Published online March 2010 | e-ISSN: 1460-2385 | DOI:
Long-term renal survival in malignant hypertension

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Background. Some studies have shown an improvement in the prognosis of patients with essential malignant hypertension (MHT), but data about long-term outcome and prognostic factors of these patients are scarce.

Methods. We performed a single-centre retrospective analysis of 197 patients with MHT, diagnosed in the period 1974–2007.

Results. Incidence of MHT remained stable along the different periods of the study. Renal damage at presentation was common (63% of patients) but renal function improved or remained stable after diagnosis in a majority of patients. The probability of renal survival was 84 and 72% after 5 and 10 years, respectively. Diagnosis during the first period (1974–85) of the study, previous chronic renal impairment, baseline renal function and proteinuria, presence of microhaematuria, systolic and diastolic blood pressure and proteinuria during follow-up were associated with an unfavourable outcome. By multivariate analysis, mean proteinuria during follow-up remained as the only significant risk factor (OR, 2.72; 95% CI, 1.59–4.64). Renal survival for patients with mean proteinuria <0.5 g/24 h was 100 and 95% after 5 and 10 years, respectively. The number of patients who improved or stabilized their renal function significantly increased in the second and third periods of the study (1987–2007).

Conclusions. Renal survival in MHT has improved in recent years. Mean proteinuria during follow-up is a fundamental prognostic factor for renal survival.

Keywords: malignant hypertension; RAS blockade; renal survival; proteinuria

Journal Article.  4063 words.  Illustrated.

Subjects: Nephrology

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